Because of a better understanding of the caries process, a decrease in the prevalence of caries, and the rapid development of dental materials, a renewed approach to the treatment of dental caries in the posterior region is possible. A decision tree for the treatment of caries in posterior teeth, taking into account some of the most recent tooth substance-saving treatment options, is presented. These possibilities gradually evolve from nondestructive to conventional cavity preparations. In addition, the preventive Class II restoration is introduced. The application of this conservative attitude toward invasive techniques offers great advantages for both the patient and the dentist. Unfortunately, this approach is time-consuming. Long-term clinical evaluation of the application of the proposed decision tree on a wide scale is needed to confirm its potential benefits or to modify and improve treatment options.