The introduction of clear aligners has profoundly changed the orthodontic treatment landscape, reshaping patient expectations and redefining market demands. Among the most challenging clinical scenarios are extraction cases, in which, based on current evidence, clear aligners do not always represent the most biomechanically efficient treatment modality when compared with fixed appliances. Nevertheless, the increasing demand for aesthetic treatment requires orthodontists to adopt a critical and evidence-based approach. The question is no longer whether extraction cases can be treated with clear aligners, but rather when such an approach is truly indicated and where the biomechanical limitations become significant enough to compromise treatment predictability and outcomes. This lecture will examine the key factors influencing clinical decision-making and propose practical criteria for patient selection based on orthodontic diagnosis, malocclusion characteristics, treatment objectives, and individual patient expectations. Through the presentation of clinical cases, situations in which clear aligners can achieve predictable, high-quality results will be distinguished from those in which biomechanical limitations increase the risk of loss of tooth movement control, reduced treatment efficiency, prolonged treatment time, and the need for auxiliaries or a change in treatment strategy. The analysis will extend beyond clinical considerations to include management and economic aspects. Appropriate case selection is not only essential for achieving optimal clinical outcomes but also plays a pivotal role in maximizing practice efficiency, ensuring treatment sustainability, managing patient expectations, and maintaining the economic viability of aligner therapy. The aim of this lecture is to provide clinicians with practical decision-making tools for managing extraction cases with clear aligners, enabling them to recognize when aligner therapy represents a predictable and effective treatment option and when alternative biomechanically more favorable approaches should be considered in the best interest of both the patient and the final treatment outcome.