Factors Influencing Parental Decision-making in Choosing Between Clear Aligners and Fixed Appliances for Their Wards in Urban India: A Twin-center Mixed-methods Study

Introduction Clear aligners are promoted as more esthetic and comfortable than fixed appliances, but how Indian parents choose between them is not well understood. Methods A cross-sectional mixed-methods study in two digital smile practices in Mumbai (Chembur, Lokhandwala) was conducted. Parents of 8-17-year-olds attending their first orthodontic consultation completed a questionnaire on sociodemographics, malocclusion, awareness and information sources, risk perceptions about at-home aligners, willingness-to-pay (WTP), equated monthly installment (EMI) acceptance, psychosocial concerns, and final treatment choice (clear aligners vs. fixed braces). Results A convergent mixed-methods design was used. Quantitative data were obtained from routine clinical records and structured questionnaires from 480 parent–child pairs treated at two urban orthodontic centers in Mumbai, India (January 2018-December 2025). The qualitative component comprised semi-structured interviews with 10 purposively sampled parents. Conclusions In urban India, parental treatment decisions for adolescent orthodontic care are shaped by a combination of esthetics, perceived effectiveness, comfort, and affordability. Transparent, evidence-based counseling and flexible payment options may help bridge the preference–uptake gap for clear aligners among urban Indian parents. Clinical Significance Transparent discussion of clinical indications, expected compliance demands, and structured EMI counseling may help align treatment decisions with both esthetic preferences and affordability.