Aim: This case report presents the correction of skeletal class II malocclusion associated with a severe skeletal open bite. Background: Using different mechanics in the same case is always challenging, especially when using class II mechanics augmented by molars intrusion. Case description: In this case report, NM, a healthy 13-year-old girl complaining chiefly of her unpleasant smile, esthetics, speech, and masticatory problems. Clinical and radiographic examination revealed a complex tongue thrust swallowing associated with a skeletal class II and severe vertical discrepancy in the form of a skeletal open bite (mandibular retrusion and clockwise mandibular rotation). The molars relationship was full unit class II bilaterally with an increased overjet of 7 mm associated with the anterior open bite of −9 mm and posterior open bite extended to the first molars. Transversely, the maxillary and mandibular midlines were shifted 1 and 2 mm to the right side, respectively. The patient had total enamel hypoplasia involving all teeth, which was more aggressive in the restored maxillary and mandibular first molars and periodontally compromised lower right central incisor. In this case, traditional (headgear) and modern (miniscrew) approaches were used to get the maximum benefits of each. The treatment involved two phases: the first was to control the habit through fixed habit-breaking appliances and occipital headgear to correct the full unit molars class II malocclusion. The second phase involved maxillary molars intrusion by miniscrew-supported intrusion mechanics with fixed appliances for the upper and lower arches, utilizing preadjusted edgewise appliances with a Roth prescription. The total treatment duration was 3 years and 2 months. A vacuum-formed retainer for both arches and a Hawley retainer with a posterior bite plane for the maxillary arch was delivered to maintain the corrected skeletal and dental malocclusions. Conclusion: The case was provided with a pleasant smile, stable occlusion, and harmonized soft tissue profile using headgear and miniscrew-supported mechanics. Clinical significance: Correction of combined anterioposterior and vertical skeletal malocclusions required proper planning and controlled orthodontic mechanics supported with patient compliance.