This case report describes a complex full-step Class II high-angle case in an adult patient treated with lingual straight-wire appliance, premolar extractions and orthognathic surgery. With the twofold aim of obtaining ideal occlusal relationship and aesthetic improvement, surgical treatment with appropriate biomechanical strategies, including anchorage control during extraction space closure, are needed to achieve the planned results. This case report demonstrates the possibility of solving successfully severe sagittal, transverse and vertical discrepancies in an adult patient with surgical treatment by means of a completely invisible technique. This report also underlines the need for precise biomechanical control, including set-up overcorrections and miniscrews to manage anchorage control, in cases of extraction in lingual orthodontics. A refinement with composite reconstructions was performed at the end to obtain the best aesthetic and functional result.