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Alveolar bone graft – a guide for children

You can download this information as a PDF leaflet here.

You can also download this booklet to help prepare your child for coming into hospital.

What is an alveolar bone graft?

A bone graft is an operation where a surgeon moves a bit of bone to a different place. During an alveolar bone graft (ABG), a surgeon takes a small bit of bone out of your hip and puts it in your gum. ‘Alveolar’ just means gum.

Why is an ABG necessary?

Lots of children born with a cleft in their lip and / or palate also have a gap in their gum. You might be able to see this or feel it with your tongue.

Gap in a child's gum

This gap can be a problem for some of your adult teeth, as they need gum to grow into. The ABG closes the gap in your gum so your teeth can grow through. If you have a hole between your mouth and nose, the operation may help close this too.

When will you have your ABG?

The best time for an ABG is different for every child. It usually happens between 8 and 11 years old, or when you get your front adult teeth.

You will find out when you need your ABG at a hospital appointment. After this, your parents / guardians will get a letter telling them when your ABG is.

Before your ABG, you need to keep your teeth very clean. Sometimes an orthodontist will put a metal or plastic ‘brace’ on your teeth to make your ABG easier. This is usually worn for a few months before and after your ABG. If you have speech therapy, it may stop for a period of time.

How will you know if you need to wear a brace?

You will find out if you need to wear a brace whenever you meet both the orthodontist and surgeon at a special clinic before your ABG. They may ask you to have some special x-rays of your teeth and gums. Afterwards, they will let you know if you need to wear a brace.

After you have your ABG, you will come along to the same clinic and the team will take new x-rays of your teeth and gums. It is important that this happens six months after you have your ABG as this will allow the team to see how successful the operation was.

Where will your ABG take place?

You will have your ABG in the Ulster Hospital. This hospital has a play room full of toys and games, including a Nintendo Switch.

In the hospital, you will stay in a place called Craig Ward. This is usually for one or two nights. There will be other children you can talk to, who will be having other types of surgery.

To help you feel at home, an adult can stay next to you. You can also bring a few toys or borrow some from the play team on the ward.

Ulster Hospital

What happens when you go into hospital?

When you go into hospital, you will go straight to Craig Ward. The nurses will tell you how long you have to wait until your ABG.

You are not allowed to eat for a few hours before your ABG. Make sure you eat and drink plenty before you go to bed the night before.

Staying busy can help if you are hungry or worried. The play team have toys and games, and most rooms have TVs.

You will also have a special spray or cream put on the back of your hand or arm. It makes your skin so numb you can’t feel it. This lets the nurses put a tiny tube in your hand to give you medicine.

You can also ask the surgeon which side of your hip you will have your scar on. The scar will be there forever, but fades over time. It will only be three to five centimetres long and can be easily covered by underwear.

What happens when it’s time for the ABG?

When you are ready, you will ride in your wheelie bed to a room with lots of machines in it. The sleep doctors will then give you some medicine, which will put you in a very deep sleep.

You can take the medicine either through a mask or through the tube in your hand. An adult can stay with you if you like.

The medicine makes your eyes feel very heavy and you will soon be fast asleep. This means you won’t feel or remember any of your ABG.

What happens during the ABG?

First, the surgeon takes a small bit of soft, spongy bone out of your hip – don’t worry, it will grow back. Next, they put this bone in the gap in your gum. Finally, they close the gap with special stitches that fall out when you are healed.

The operation usually takes about two hours – around the same time as a football match – but you won’t feel or remember any of it. The surgeon will numb your hip and gum before you wake up, so you won’t feel a thing.

How will you feel afterwards?

Some children can feel sick or dizzy when they wake up, but the nurses will quickly help. You will have a tube of water in the back of your hand so you don’t get thirsty.

Your mouth may look or feel swollen, so talking might be a bit funny. It will feel numb too, so be careful not to bite your lip. The special stitches in your mouth will dissolve away.

Your hip may also feel slightly sore, but don’t worry – you will look and feel back to normal soon.

You will get medicine to stay comfy and you should be home in a night or two. After a week or two off school and lots of rest, you should feel fine.

What can you eat afterwards?

You probably won’t want to eat much at first. But when you do, you will only be allowed soft foods like soup, mash or ice cream.

What do you need to do when you get home?

When you get home, you need to brush your teeth, gum and stitches (be gentle around the stitches) and use special mouthwash. It is very important to keep your mouth clean.

The stitches are blue and the surgeon will know if you have brushed your teeth, because if you don’t they turn white!

You will need to rest from exercise for four weeks and rest from contact sports (like rugby or karate) for eight weeks. Think of other fun things you can do instead.

What if you feel worried?

Most people feel a bit worried about going to hospital. This is totally normal. If you are worried about having your ABG, tell your parents / guardians. They can answer your questions or find out things you want to know.

If you are very worried, someone from the hospital can chat to you to help you feel better.