Time has passed since the prevention of caries was performed by extending cavity preparations wide in the tooth and below the gingiva. In the same period adhesive techniques have improved and nowadays made it possible to extend the indications for direct composite resin restorations, also when rather destroyed teeth need to be restored. Although much can be solved by direct fillings and thereby make treatments less invasive for the tooth and less expensive for the patient, there still will be teeth, where the prognosis is improved, if an indirect restoration in terms of an inlay, onlay or crown is made. Factors as remaining tooth structure, endodontic treatment, number of teeth, caries risk, parafunctional habits, material properties, economy etc. will all have an influence, when the dentist guides the patient to choose the best solution. What is best for the tooth – direct or indirect? How do patient related variables influence the choice? And what lies under the decision between direct or indirect?