The aim of the study was to evaluate the marginal performance of direct composite additions for the correction of 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, marginal performance was assessed by two evaluators in terms of marginal adaptation and retention, clinical microleakage, and caries recurrence. Marginal adaptation and clinical microleakage were judged on the vestibular, palatal, and proximal planes. In addition, these planes were divided into a cervical and an incisal part. No caries recurrence was noted at 5 years and no restoration was lost. Concerning marginal adaptation, only four restorations (5%) presented a severe incisal chipping and needed replacement. The restorations showed a significantly (P < 0.05) higher percentage of perfect margins incisally (37%) than cervically (15%). Canines showed the best cervical marginal adaptation (29% with perfect margins), the best results being with small unilateral restorations. Concerning clinical microleakage, 7% of the restorations were rated as clinically unacceptable due to severe marginal discoloration. Clinical microleakage was significantly more often (P < 0.05) found among smokers. In conclusion, an ultrafine midway-filled densified composite is indicated for use in stress-bearing areas in the anterior region. The type and location of the restoration are determining factors for marginal integrity.