A combined orthodontic and surgical approach is often the treatment of choice for the correction of severe dentofacial deformities. Numerous orthognathic surgical procedures have been developed for this treatment. It is clear that certain orthognathic surgical procedures have a tendency to relapse; many studies have been conducted in an attempt to create a pattern of predictability and a prognosis of stability. This article reviews the literature briefly and presents four cases in which the combined surgical and orthodontic approach produced less than satisfactory results. The small number of patients does not permit statistical evaluation or firm conclusions regarding the occurrence and the etiology of relapse in general. This article underlines the importance of long-term follow-up for all patients treated with a combination of orthodontics and orthognathic surgery. World J Orthod 2005;6:125–140.