Objectives: The aim of this study was to compare the accuracy and agreement of scanned film and digital periapical radiographs for the measurement of apical root shortening. Study design: Twenty-four film and digital [phosphor plate sensor (PPS)] periapical radiographs were taken using the long-cone paralleling technique for six extracted teeth before and after 1mm of apical root trimming. All teeth were mounted using a typodont and the radiographs were recorded using a film holder and polysiloxane occlusal index for each tooth to ensure standardization during the different radiographic exposures. The film radiographs were scanned and the tooth length measurements for the scanned film and digital (PPS) images were calculated using Image-J-Link 1.4 software (http://rebweb.nih.gov/ij/index.html) for the two groups. The accuracy and agreement among the tooth length measurements from each group and the true tooth length measurements were calculated using intra-class correlation (ICC) tests and Bland and Altman plots. Results: A high level of agreement was found between the true tooth length measurements and the scanned film measurements (ICC=0.979, limit of agreement 0.579 to -0.565) and the digital (PPS) radiograph measurements (ICC= 0.979, limit of agreement 0.596 to -0.763). Moreover, a high level of agreement was found between the scanned film and digital (PPS) radiographs for the measurement of tooth length ICC=0.991, limit of agreement 0.411-0.231. Conclusion: Film and digital (PPS) periapical radiographs are accurate methods for measuring apical root shortening with a high level of agreement.