The advent of three-dimensional (3D) and four-dimensional (4D) printing technologies has significantly improved the fabrication of advanced materials, with MXene-based composites emerging as a particularly promising class due to their exceptional electrical, mechanical, and chemical properties. This review explores the fundamentals of MXenes and their composites, examining their unique characteristics and the underlying principles of their synthesis and processing. We highlight the transformative potential of 3D and 4D printing techniques in tailoring MXene-based materials for a wide array of applications. In the field of tissue regeneration, MXene composites offer enhanced biocompatibility and mechanical strength, making them ideal for scaffolds and implants. For drug delivery, the high surface area and tunable surface chemistry of MXenes enable precise control over drug release profiles. In energy storage, MXene-based electrodes exhibit superior conductivity and capacity, paving the way for next-generation batteries and supercapacitors. Additionally, the sensitivity and selectivity of MXene composites make them excellent candidates for various (bio)sensing applications, from environmental monitoring to biomedical diagnostics. By integrating the dynamic capabilities of 4D printing, which introduces time-dependent shape transformations, MXene-based composites can further adapt to complex and evolving functional requirements. This review provides a comprehensive overview of the current state of research, identifies key challenges, and discusses future directions for the development and application of 3D and 4D printed MXene-based composites. Through this exploration, we aim to underscore the significant impact of these advanced materials and technologies on diverse scientific and industrial fields.