AbstractClinical and epidemiological studies in the field of periodontics and endodontics often utilize radiographs to monitor or measure the changes in bone structure and density. Periodontal bone loss or gain can be quantified on a radiograph by measurement of the distance between the bottom of the bony pocket and the apical contour of the involved tooth. The objective of this investigation was to study the accuracy of an image analysis system (IAS) to measure changes in height of the interproximal crest on radiographs. Artificial bone lesions were introduced in a dissectioned part of a human mandible. The distances between crest and apices were measured with a micrometer (MM). Radiographs were produced with horizontal and vertical deviations of 10°. The radiographs were digitized and processed by computer. The landmarks in the digital image were enhanced mathematically and by histogram‐based thresholding. The depth of the introduced defect was increased 6 times, followed by the measurement procedure. The IAS produced measurements of crown‐apex distances with an accuracy of 0.066 to 0.358 mm. Repeated crest height measurements were recorded with an accuracy of 0.112 to 0.184 mm. Both the histogram‐based binarization and the ellipse‐fitting type of contour detection could be applied precisely. Misangulation errors during radiographic exposure of 10° horizontal or vertical did not statistically significant influence the IAS‐measurements. The IAS can be applied in clinical trials and follow