Occlusal asymmetry is a common finding in Class II malocclusion, even in mixed dentition. A question frequently addressed during the clinical practice, is the source of the asymmetry: is it predominantly dentoalveolar, skeletal, or a combination of both? Part of the decision in treatment selection and the detailed treatment plan that determines tooth position in three-dimensional space is based on differentiating skeletal from dental problems. In literature, the prevalence of skeletal asymmetry is reported to be smaller than dento-alveolar asymmetry. True dental asymmetries are related not only to congenitally missing teeth, but more frequently to differences in the size of teeth or their location in the arches. In particular, a distal positioning of the mandibular first molar on the Class II side with a mandibular dental midline deviation toward the Class II side is reported to be the major factor. A secondary factor is the mesial positioning of the maxillary first molar on the Class II side with a maxillary dental midline deviation away from the Class II side. The complexity of treatment is also attributed to the association of dental asymmetry with functional asymmetry. There are many treatment options such as asymmetric mechanics with clear aligners. By evaluating parameters such as axial inclinations of teeth and the amount of space available, valid judgments can be made to assist in developing an appropriate treatment plan. In addition, the plastic thickness between the arches may be able to eliminate habitual posturing and deprogramming the musculature, making the mechanics more efficient.