Although mandibular advancement by bilateral sagittal split osteotomy seems to be a good mandibular treatment option to treat skeletal class II malocclusion, it is less stable than setback; relapse depends on a wide range of patient-centered and surgeoncentered factors relating to the skill and experience of the surgeon, proper seating of the condyles, the exact amount of mandibular advancement, the tension of the muscles and soft tissues, the mandibular plane angle, and the patient's age. In fact, patients with low and high mandibular plane angles have increased vertical and horizontal relapses, respectively. Nonsurgical management of class II malocclusion may be an option by which to effectively manage such cases. The present chapter discusses different treatment modalities for clinical management of class II malocclusion in growing and non-growing patients.