The aim of this study was the determination of image accuracy and quality for periodontal diagnosis using various X-ray generators with conventional and digital radiographs. Thirty-one in vitro periodontal defects were evaluated on intraoral conventional (E-, F/E-speed) and digital images (three indirect, two direct sensors). Standardised radiographs were made with an alternating current (AC), a high-frequency (HF) and a direct current (DC) X-ray unit at rising exposure times (20-160 ms with 20-ms interval) with a constant kV of 70. Three observers assessed bone levels for comparison to the gold standard. Lamina dura, contrast, trabecularisation, crater and furcation involvements were evaluated. Irrespective X-ray generator-type, measurement deviations increased at higher exposure times for solid-state, but decreased for photostimulable storage phosphor (PSP) systems. Accuracy for HF or DC was significantly higher than AC (p < 0.0001), especially at low exposure times. At 0.5- to 1-mm clinical deviation, 27-53% and 32-55% dose savings were demonstrated when using HF or DC generators compared to AC, but only for PSP. No savings were found for solid-state sensors, indicating their higher sensitivity. The use of digital sensors compared to film allowed 15-90% dose savings using the AC tube, whilst solid-state sensors allowed approximately 50% savings compared to PSP, depending on tube type and threshold level.. Accuracy of periodontal diagnosis increases when using HF or DC generators and/or digital receptors with adequate diagnostic information at lower exposure times.