Approximal carious lesions provide unique diagnostic and restorative challenges for clinicians interested in conserving tooth structure. Direct access reduces diagnostic doubt and facilitates optimal restorative management. The direct access afforded to newly erupted posterior teeth provides an imcomparable window of opportunity to the proximal surfaces. Optimal management is limited to the interval between exfoliation and eruption, because access is lost once the erupting adjacent permanent teeth come into contact. Diagnostic and restorative strategies accomplished after creation of direct access to approximal lesions are discussed.