The antimandibular jaw, commonly known as the “envelope” or “pocket tooth”, seriously affects the facial aesthetics and chewing function of patients, and patients and parents urgently request treatment. Many parents ask: Why does the child have a mandible when there is no relative with a mandible in the family? Is it true that the earlier the antimandibular is treated, the better? There are also some adult patients who are concerned about whether they can solve the antimandibular problem without surgery. What kind of results can be achieved by orthodontic treatment alone? There is a genetic predisposition to jaw rejection, but genetic factors are not the only cause of jaw rejection. It should also be noted that the facial shape (“crescentic”, “shoe-pulled”, “large chin”) of parents and close relatives with a tendency to antimandibulate also has some influence. In addition, some respiratory diseases, poor oral habits, incorrect artificial feeding, and impaired tooth replacement may lead to anterior retrusion. The orthodontic treatment of jaws is controversial and can be divided into the following periods: 1. The period of milk teeth This period of orthodontic treatment uses movable aligners, which can be removed by the child himself, and the aligners will have some impact on eating and pronunciation, requiring about a week of adaptation time. This period requires the child’s cooperation, and if he or she cannot cooperate in taking the model or wearing the aligner, the orthodontic treatment will not be possible. If the child is able to cooperate well, the orthodontic treatment can be finished in about six months. The main purpose of orthodontic treatment in this period is to establish the correct anterior-posterior relationship of the front teeth in order to promote maxillary growth, in addition to the temporary release of the antimandibular. This period of orthodontic treatment for patients with underdeveloped upper jaw, the use of orthopedic forces to promote the development of the upper jaw, the more commonly used is the anterior traction aligner, still requires the cooperation of the patient, the course of treatment for about a year. For functional and bony antimandibles with underdeveloped maxillae, functional orthoses can be used during this period. It is worth noting that the effect produced by orthodontic treatment during this period is to promote maxillary development and anterior displacement of the upper dentition, with the lower jaw producing only a posterior inferior direction of rotation and not inhibiting the development of the lower jaw. In patients with normal upper jaw development and excessive lower jaw development, there is no effective method to inhibit lower jaw development during this period. In the past, some doctors advocated the use of a head cap-chin pocket orthosis to inhibit jaw growth, but clinical studies have shown that the chin pocket only changes the direction of the jaw, but does not inhibit jaw growth, and after stopping the chin pocket, the jaw will experience “rebound” growth. Therefore, this orthodontic appliance is no longer used in clinical practice. Both of these treatments are early treatments, mainly for the upper jaw, but the patient’s growth pattern, especially the lower jaw growth pattern can not be changed. In some patients, the anterior retrusion may reappear after early treatment, and this “recurrence” is very unpredictable. This is the reason why some clinicians do not recommend early orthodontic treatment. Should we still do early orthodontic treatment? Is it better to treat the retrognathism as early as possible? We believe that it is important to treat the retrognathism as early as possible. Although the recurrence of retrognathism cannot be completely avoided, early orthodontic treatment can promote the growth of the upper jaw and reduce the disproportionate development of the upper and lower jaws, which can reduce the difficulty of subsequent treatment or even avoid later treatment. In addition, the anti-jaw not only affects the facial aesthetics and function, but also has a certain impact on the patient’s psychology. Timely correction of the anti-jaw can eliminate the negative impact of facial deformity on the patient’s psychology. 3, pure orthodontic treatment in permanent dentition Pure orthodontic treatment is only for patients with dental, functional and mild bony antimandibles. It should be noted that orthodontic treatment alone is limited in improving the facial shape of patients with bony antimandibles. The growth of the lower jaw often has a greater potential beyond the growth spurt, i.e., the jaw may still change significantly after the height has stabilized. Therefore, for patients with bony antimandibularity, they should wait for the facial shape to stabilize before deciding to use simple orthodontic treatment or combined orthodontic-orthognathic treatment. 4. Combined orthodontic and orthognathic treatment Although most patients do not want to choose surgical treatment, for patients with bony antimandibular, especially those with lower jaw deviation, they still need to use combined orthodontic-orthognathic treatment after the completion of growth and development if they want to achieve good orthodontic effect, especially the improvement of facial shape. This phase of treatment requires the orthodontist and orthognathic surgeon to jointly develop a treatment plan, and the patient needs to go through three stages: preoperative orthodontic, surgical, and postoperative orthodontic, with the whole course of treatment in about three years.