Introduction: Class II Division 1 malocclusions are characterized by a retrusive mandible and prominent upper incisors. Despite Class II malocclusions being one of the most frequently treated cases in orthodontists' office, there is no uniform consensus in the orthodontic community on the best treatment modality and biomechanical approach to use in treating patients with Class II malocclusions. Purpose: This paper examines the end-of-treatment outcomes of severe Class II Division I malocclusion patients treated with surgical versus non-surgical approaches. Study Design: This is a retrospective study of consecutively treated severe Class II Division I patients at the University of Iowa. Initial and deband lateral cephalometric radiographs were compared between 45 non-surgical and 21 surgical patients. All patients that were debanded between the ages of 13 to 19 years were included. Multivariable regression analyses were used to examine differences in outcomes between treatment groups. Results: Following adjustment for patient level confounders (age, gender, and race), those treated surgically had better end of treatment cephalometric outcomes. Those treated surgically had a more balanced skeletal profile, greater reduction in overjet, and improvement in ANB angle (p Conclusion: Orthodontic treatment in conjunction with orthognathic surgery is a more ideal treatment for patients with severe Class II Division I malocclusion. When treated surgically, a greater amount of overjet can be reduced while keeping lower incisors in a more stable position in bone.