OBJECTIVE To evaluate the effectiveness of digital subtraction radiography (DSR) system for diagnosis of small artificial alveolar bone lesions. METHODS Seventy-two 0.2-0.9 mm3 lesions were produced in premolar and molar areas of dry human mandibles. Reference and subsequent radiographs were taken before and after lesions were made. The small lesions were detected by conventional radiography and DSR respectively. RESULTS For 0.2-0.5 mm3 lesions, detection by both DSR and conventional methods was less than 50%. For 0.7 mm3 lesions, the detection by DSR and conventional methods was 57.5% and 38.7%, respectively (P < 0.01). For 0.9 mm3 lesions, the accuracy of the detection by DSR and conventional methods was 89.3% and 57.3% (P < 0.01). CONCLUSIONS The detectability of small alveolar bone lesions by DSR was superior to that of the conventional method.