The aim of the study was to evaluate the esthetic performance of direct composite additions in correcting tooth form and position at 5 years. Composite additions were directly placed using the acid-etch technique and enamel bonding on 87 intact maxillary anterior teeth in 23 young patients (12-19 years old). The restorations were made by one operator using an ultrafine midway-filled densified restorative composite. Color slides were made at baseline and 5 years. At the 5-year recall, esthetic performance was assessed clinically by two evaluators at chair-side in subterms of color match, translucency/opacity, surface roughness, and anatomical form. Five additional examiners scored esthetics on the 5-year slides. Of the restorations, 89% were still esthetically satisfactory after 5 years of clinical service. The remaining restorations needed replacement, mainly because of severe loss of anatomical form, to a lesser degree because of severe color mismatch. Central incisors and small unilateral restorations generally showed the best results concerning color match (68% and 74%, respectively) and surface smoothness (84% and 100%, respectively). The slide scores on color match and translucency/opacity were generally similar or somewhat better than the direct clinical scores; however, the difference were not statistically significant (P > 0.05). As far as surface roughness is concerned, the results were significantly better (P < 0.05) when recorded indirectly than by direct clinical evaluation. In conclusion, direct composite additions are a valuable and effective procedure for esthetic and conservative treatment of malformed and misaligned anterior teeth. Loss of anatomical form due to wear points to a shortcoming of the composite material used, with which a durable esthetic result cannot always be guaranteed in the long term.