**5. Relapse in SFA**

The short- and long-term relapse rates in SFA have been investigated, and the results are good by comparison with the conventional surgical approach with a maximum follow-up of 3 years [19, 57–59]. Without presurgical orthodontics, the patients may have likely to develop unstable occlusion after surgery leading to relapse. However, some of the comparative studies between conventional and surgery first approach showed no statistical differences in relapse and almost equal for those achieved using the more traditional orthodontics-first approach [17, 19, 51, 53, 59–63]. Advancement of fixation system enabled more stabilized results due to more stable fixation of bony segments. On the other side, based on one research and on the meta-analysis, SFA showed more relapses than in the conventional approach [57, 64]. Larger overbite, a deeper curve of Spee, a greater negative overjet, and a greater mandibular setback were reported to affect stability in SFA cases [59].

Although there are benefits of the SFA, there are some difficulties like the prediction of final occlusion, instability of postsurgical transient occlusion [10, 65], the requirement of presurgical orthodontic setup before surgery in some complex cases, and requirement of frequent orthodontic appointment due to RAP. The treatment plan requires detailed and meticulous planning.
