Clinical decision-making in the treatment of Class II malocclusion in growing patients requires a rigorous integration of Evidence-Based Orthodontics with individualized diagnosis and biomechanical expertise. This approach is founded on three pillars: patient-specific genotype and phenotype, the orthodontist’s diagnostic and biomechanical skills, and the available scientific literature. In the absence of robust evidence, particularly in extraction protocols involving both arches, clinical responsibility relies on professional judgment and case-specific factors. A structured front-to-back diagnostic workflow is proposed to guide treatment planning, including anterior limit of dentition, lower arch space analysis, extraction protocol selection (4/4 or 4/5), anchorage management, and vertical control. Therapeutic goals focus on realistic dentoalveolar corrections, facial and smile esthetics, periodontal health, occlusal stability, and long-term outcomes. Successful outcomes depend on clear visualization of treatment objectives, controlled force systems, appropriate anchorage strategies, and patient compliance.