The longevity of dental restorations is dependent on many different factors, including those related to materials, the dentist, and the patient. The main reasons for restoration failure are secondary caries, fracture of the bulk of the restoration or of the tooth, and marginal deficiencies and wear. The importance of direct-placement, aesthetic, tooth-colored restorative materials is still increasing. Amalgam restorations are being replaced because of alleged adverse health effects and inferior aesthetic appearance. All alternative restorative materials and procedures, however, have certain limitations. Direct composite restorations require a time-consuming and more costly treatment procedure and are actually only indicated for patients with excellent oral hygiene. Glass ionomers can be considered only as long-term provisional restorations in stress-bearing posterior cavities. Future treatment regimens that are made possible by the development of sophisticated preparation techniques, improved dentin bonding agents, and resin-based restorative materials will result in the therapy of more small-sized lesions rather than large restorations. The importance of indirect inlay techniques will shift more and more toward the direct restoratives. As the cavities become smaller, it is to be expected that the use of improved direct restorative materials will provide excellent longevity even in stress-bearing situations.