Aim: To establish the etiology of complications in patients undergoing treatment of maxillofacial trauma and justify the treatment of choice. Methods: Four patients with posttraumatic occlusal irregularities comprised the subjects. Results: Posttraumatic malocclusion has a complex etiology. The evaluation of the pretraumatic occlusal relationship is useful but not always possible. Anatomic repositioning of the fracture should be performed as soon as possible. Patients whose fractures are treated via maxillomandibular fixation who do not receive surgical reduction of a posttraumatic fracture have a greater possibility of later developing more severe dental and skeletal malocclusions. In cases treated via maxillomandibular fixation, Ivy loops should be avoided. Conclusion: When treating patients with maxillofacial trauma, care should be taken to counterbalance possible obstacles. This will result in a satisfactory posttraumatic occlusal scheme, without the need for orthodontic treatment or a second surgery. World J Orthod 2007;8:335–343.