Pediatric mainstream clear-aligner early orthodontic orders in Guangdong public tertiary hospitals: service patterns, service-duration tiers and order conversion.

BACKGROUND: Early orthodontic assessment is increasingly recognized as part of child oral-health and dentofacial developmental care. Clear-aligner therapy has expanded from adult permanent-dentition treatment to selected mixed-dentition and adolescent indications, but real-world evidence on pediatric clear-aligner service delivery in public hospital settings remains limited. This study examined pediatric mainstream clear-aligner orders in Guangdong, China, focusing on annual service patterns, city-level distribution, service-duration tiers, clinician participation and manufacturer-observed order conversion.

METHODS: This retrospective observational real-world service study used de-identified operational order records from public tertiary hospital settings in Guangdong. Eligible records were restricted to commercially manufactured pediatric mainstream clear-aligner orders with one-year, two-year or six-year service-duration categories; no in-house aligners were included. These categories mainly target children approximately 6-13 years of age in late primary, mixed and early permanent dentitions and were treated as administrative service tiers rather than validated clinical severity grades. Order conversion was defined as a non-missing production-scheduling date. Descriptive analyses summarized service-duration tier, year, city, public hospital institution type and anonymized clinician-account participation. A multivariable logistic regression model with city-clustered robust standard errors estimated exploratory associations with conversion.

RESULTS: A total of 4,531 pediatric mainstream clear-aligner orders were submitted, and 3,994 progressed to production scheduling, yielding a crude conversion rate of 88.1%. The one-year, two-year and six-year categories accounted for 2,202, 2,048 and 281 orders, respectively, with conversion rates of 91.9%, 85.2% and 80.1%. By manufacturer-defined service-function positioning, the one-year and two-year categories were not positioned for extraction-including or molar-distalization pediatric workflows and accounted for most submitted and converted orders. A total of 362 anonymized clinician accounts submitted pediatric orders, and 346 had at least one converted pediatric order. Guangzhou and Shenzhen contributed the largest order volumes. Public stomatological hospitals had a higher crude conversion rate than Departments of Stomatology of public general hospitals (91.7% vs. 81.3%). Exploratory adjusted modeling suggested associations with service-duration category and institution type, but these findings were interpreted as service-process signals rather than clinical efficacy or treatment success.

CONCLUSIONS: Pediatric mainstream clear-aligner early orthodontic orders showed heterogeneity by year, service-duration tier, city, institution type and clinician-account participation. The findings describe administrative ordering and production-scheduling patterns within a defined public-hospital manufacturer channel and should not be interpreted as evidence of clinical effectiveness, patient benefit, population-level treatment coverage or unmet need. Future research should link verified patient-residence data, official child-population denominators and clinical diagnostic records to estimate population-adjusted utilization and need-service alignment.