This research aimed to evaluate the effects of presurgical mandibular incisor decompensation on long-term outcomes of Class III surgical orthodontic treatment. Thirty-five patients with skeletal Class III malocclusion who received conventional surgical orthodontic treatment were included. Mandibular incisor brackets with -6 degrees of inclination were placed normally in 18 patients (NB group) and inversely in 17 patients (RB group). Between-group differences and relationships between incisal and skeletal variables were analyzed based on lateral cephalograms at pretreatment, presurgery, postsurgery, posttreatment, and retention. Mandibular incisors were more labially inclined in the RB group than in the NB group from presurgery to retention. No significant between-group differences were observed in presurgical and postsurgical skeletal relationships. The NB group exhibited a larger overjet with deficient interincisal contact at postsurgery than the RB group. Skeletal Class III relationship was also more severe in the NB group at retention. More lingually inclined mandibular incisors at presurgery and larger overjet at postsurgery were correlated with a more severe skeletal Class III relationship at retention. Thus, establishing appropriate postsurgical overjet by sufficient presurgical mandibular incisor decompensation may play a significant role in postsurgical stability of Class III surgical orthodontic treatment.