Purpose: The aim of this study was to compare the cumulative survival rates and the complication rates of established methods of indirect cast posts and cores and direct posts and composite cores over at least 5 years within a retrospective study of patients who received fixed restorations. Materials and Methods: The patients were questioned according to a protocol and were examined clinically and radiologically. Of the 101 patients who were recruited, 72 came for a follow-up examination. Results: Forty-one cast posts and cores and 31 composite cores were examined clinically and radiologically after an average observation period of 8.56 (SD 1.45) years. Four teeth were extracted during the observation period, and 2 more were extracted at the time of the examination. This resulted in cumulative survival rates of 90.2% for cast posts and cores and 93.5% for composite cores. There were 28 complications altogether, consisting of 2 (7.1%) root fractures, 8 (28.6%) teeth with increased probing depths, 3 (10.7%) with increased degrees of mobility, 4 (14.3%) with caries, 9 (32.1%) with periapical radiolucency and/or retrograde filling, and 2 (7.1%) with loss of retention. No statistically significant differences between the 2 methods could be found regarding survival and complication rates. Conclusion: It can be concluded that over an average observation period of 8.56 years the indirect cast post-and-core buildup and the direct composite post buildup can be considered of similar value.