The Alveolar Bone Graft is an operation which helps adult teeth to come through properly. It usually happens when you're between 8-12 years old.
This page is aimed at young people born with a cleft. We also have a page on the Alveolar Bone Graft aimed at parents, carers and family members.
The Alveolar Bone Graft is an operation which helps adult teeth to come through properly. It usually happens when you’re between 8-12 years old.
This page has general information about the Alveolar Bone Graft. Your Cleft Team will give you lots of more specific information and can answer any questions you have.
A Child's Guide to Alveolar Bone Graft (ABG)
If you were born with a cleft, you might have a gap in your alveolus, which is the bone under your gum where your teeth sit. This gap can stop your adult teeth from growing properly.
An Alveolar Bone Graft operation is when a piece of bone is taken from one part of your body (usually your hip, sometimes your shin) and is put into the alveolus to fill the gap in your gum.
After your baby teeth fall out, your adult teeth will start to come through.
If your cleft goes through your gums, there might be a gap in the bone underneath the gums (called the ‘alveolus’). This can mean that your adult teeth in this part of your mouth might not be able to come through properly.
It’s very important that your gums are strong enough to hold your adult teeth. This operation fills the gap in the bone under your gum so that it’s ready for your adult teeth to come through.
If you were born with a cleft palate, you might still have a small hole in the roof of your mouth where air, food and drinks can come through. This is called a fistula. If you have an ABG operation, your surgeon might also close any holes in your palate at the same time.
It usually happens when you’re between 8 and 12 years old, but it might be earlier or later. It depends on how your adult teeth are growing.
Your surgeon (a doctor who does operations) and your orthodontist (a doctor who helps your teeth to be in the right place) will look at how your teeth are growing. This will help them to decide on the best time for you to have the operation.
When you’re around seven or eight years old you’ll meet your orthodontist and surgeon.
They will check your gums with an x-ray (a machine which takes pictures of the inside of your body) to see if you will need an ABG operation.
The x-ray will show them if there is a gap in the bone under your gum. It will also show them how fast your adult teeth are growing under your gums. This tells them when you will need this operation.
People born with a cleft often have extra or missing teeth around the area of their cleft, and the x-ray will show this as well.
When you were a baby, you had one or more operations to repair your cleft. You might have had more operations since then.
When you were younger, you were too small for an ABG operation to work properly. The best time for the operation to happen is just before your adult teeth start to come through.
If you don’t have an ABG operation, the gap in your gum will stay there and your adult teeth might not be able to come into your mouth properly. You might not be able to use braces to straighten your teeth in this part of your mouth, because there won’t be any bone for the teeth to move around into. It also might stop you from being able to get other treatment for your teeth when you’re older.
Your Cleft Team can explain to you the reasons why they think you should have the operation. This should include explaining what will happen if you don’t have it.
It’s normal to be worried about an operation like this. Make sure you talk to an adult you trust about any worries you have. You can learn more about how to deal with these worries further down this page.
Having an operation isn’t fun, but it will be worth it in the end. Try to think positively about how you will feel in the future once it’s over, instead of how you might feel now.
Right now, the ABG operation is the only way to fill the gap in your gum and help your adult teeth grow properly.
Everyone’s mouth is different. Your orthodontist will look at how your teeth are growing and will tell you if you need to wear braces to get your teeth ready for the ABG operation.
The braces will help to straighten your teeth and gently open the gap in your gum to make sure the surgeon has enough space to add the small piece of bone during the operation.
These might be braces you can take off at night, or they might be fixed (‘glued’) to your teeth. These might only be on your top teeth. You’ll usually need to keep them on for a year, but sometimes you will keep them on for longer.
When your orthodontist thinks your teeth are ready for the ABG you’ll either keep your current braces on or get a smaller brace. This will make sure your teeth stay in the right place for your ABG operation.
Your Cleft Team want you to grow up with strong, straight teeth that you’re happy with. The ABG operation and braces are a part of this.
Your orthodontist also wants to make sure you are happy with what’s happening, so make sure you speak up if you would prefer to have braces sooner, later, or if you have any questions or worries.
It’s really important your teeth are kept clean when the braces are on, so brushing your teeth needs to be a top priority.
Braces can make it harder to clean your teeth properly, so your orthodontist will show you how to keep them clean and give you other tips.
Try not to have food or drinks with lots of sugar as these can damage your teeth. You should also try not to have sticky foods because they could break your braces.
If you still have baby teeth in the part of your gum affected by your cleft these will need to be taken out.
Having these baby teeth taken out gives your orthodontist and surgeon more room to work inside your mouth.
Your orthodontist or surgeon will talk to you about when and how your baby teeth will be removed. It usually happens before your ABG operation, but if they are difficult to remove the baby teeth will be taken out during the operation itself.
After the ABG operation, your adult teeth can take a year or longer to come through into your mouth.
Everyone’s mouth is different, so talk to your Cleft Team about what you can expect.
Your orthodontist will check on these teeth and might take another x-ray around six months after your operation to make sure everything’s okay.
You will have an appointment with your Cleft Team where they will explain why you need this operation and how it will work.
This is a good chance to ask any questions you might have. You might want to make a list of questions to bring with you; ask your parent or carer for help with this.
Having this operation is your choice. It’s important that you listen carefully to the reasons why you are being offered this operation and talk about any worries you have so the Cleft Team can help you feel better about it.
Once you agree to go through with the operation, your parent or carer will be asked to sign a consent form.
Before your operation you will have a medical check-up, either at the hospital or over the phone. This is to make sure you are fit and healthy for the operation.
You will be told the date of your operation so you can make sure you’re ready. Your parent or carer can help you to pack a bag of things to take with you to hospital and tell your school that you will be having some time off.
It’s very normal to be worried about operations. Try to keep busy and distract yourself with things you enjoy so you don’t spend all your time thinking about it, especially in the days just before the operation.
Talk to your parent or carer about any worries you have about the operation. What are you worried might happen? Is there anything you’re not sure about? If your parent or carer doesn’t know the answers, they can help you find out.
Your Cleft Team can also help you to feel better about the operation. Your surgeon and orthodontist can answer any questions you have about the operation.
You might be able to talk to the psychologist in your Cleft Team as well. They can help you and your family talk through your worries and give you tips on how to make things easier.
There is no such thing as a ‘silly’ question, especially if something is making you worried. Your Cleft Team want to do everything they can to make you feel as comfortable as possible.
You might be able to visit the hospital and ward where you’ll be staying for your operation, and meet some of the people who will be looking after you. This may make you feel less nervous about going into hospital.
Your hospital ward might also have ‘play specialists’ – workers who help you stay calm when you’re in hospital. If you’re very nervous your parent or carer can ask the hospital about this.
You can read more about what happens when you go into hospital and what happens afterwards to get a better idea of what to expect.
You might also like to talk to another young person who has already had their ABG operation, or watch William’s ABG video diary.
You might want to ask your parent or carer to contact Pyjama Fairies, a charity which makes special hospital gowns in fun, colourful fabrics for children and young people.
I was in for just one night. However, in a hospital environment, a day and a half feels like a very long time. I found that the best way to deal with it is just to make the most out of it and have a bit of fun with it.Young person who had an ABG operation
Hospitals might seem like really boring, really horrible, not the nicest places, but I think actually it can be fun – the wards are full of stuff to do and they've got really nice people to chat to.
You can’t eat or drink anything before your operation. This is called ‘fasting’.
You will usually be told a specific time the night before when you have to stop eating and drinking.
It can make you very sick if your tummy is not completely empty for your operation, so make sure you do exactly what the Cleft Team tell you to do, and tell them if you have any worries about this.
You usually need to go to the hospital early in the morning. If you live far away you might have to go the night before and stay somewhere nearby.
When you and your parent or carer get to the ward (the part of the hospital where you’ll be staying), you’ll have a final check-up to make sure you’re ready for the operation.
You will usually meet your surgeon, your anaesthetist (a kind of doctor who makes sure you are asleep for the operation), and the nurses who will be looking after you.
If you have a bad cough or cold your operation might be delayed until you are better.
You will have to wait until it’s your turn to have your operation. This can take a while, so it’s a good idea to have lots of fun things like books and games to distract yourself with.
For this operation you will have a general anaesthetic, which is where your whole body is put to sleep using special medicines so you don’t feel anything.
A type of doctor called an anaesthetist will give you this medicine. They might come to talk to you when you’re waiting for your operation to tell you what will happen.
Your parent or carer can stay with you while you’re being given this medicine.
This medicine is normally given to you by putting a small tube (like a very thin straw) in the back of your hand. They will put some special ‘numbing cream’ on your hand so you don’t feel anything when the tube is put in.
Sometimes this medicine is given to you by putting on a special mask and breathing in gas and air.
If you’re worried about this, talk to your cleft team. They might be able to change things to make you more comfortable. This could mean having fewer people in the room, listening to music, or having the medicine given in a certain way. It’s not always possible to make these changes, but it’s always worth asking.
This isn’t like normal sleep. The special medicine will make you fall asleep very quickly and it will make sure you stay asleep and feel nothing at all during the operation. You will wake up hours later and won’t remember anything that happened when you were asleep.
The surgeon will make a small cut in your hip (around 4-6cm), and take a small piece of bone from inside one of your hip bones. The piece they’ll take is about the size of a 10p coin. It will soon grow back.
This piece of bone is put into your gum where your cleft has left a gap in your alveolus (the bone your teeth ‘sit’ in). Your gum and your hip are then stitched up so they can heal.
If you need any teeth removed or a fistula (small hole in the roof of your mouth) closed, this will happen during the operation as well.
The operation takes around 2 to 3 hours. It takes a long time because your surgeon wants to make sure they’re doing a good job and making everything as neat as possible.
You will be asleep the whole time and won’t feel or remember anything.
When you wake up, you will be in a special ‘recovery room’. You will probably still feel very sleepy.
Your mouth and hip will be numb, which can feel strange. You will have some small stitches in your mouth and a sticky plaster on your hip. You will be given some medicine to stop your mouth and hip from hurting.
You can have a drink right away and can eat some soft food when you are ready.
When you wake up from the operation your lips and cheeks will look a bit swollen, and your hip might be swollen too. You might look bruised as well. This will calm down after a few days.
You won’t feel anything during the operation. You will be given special medicine to make you fall asleep and stay asleep the whole time.
When you wake up, you will have medicine to stop your mouth and hip hurting when you wake up. If it still hurts, tell a doctor or nurse and they can help you.
You might have a sore throat or feel a little sick after your operation, but you will soon feel better.
When you’re at home recovering, you might feel sore, but you will have medicine to take home which can help.
You will usually be able to go home the day after your operation as long as you feel well enough.
If your operation was early in the day, and you feel well enough, you might even go home on the same day.
The nurses looking after you will make sure you can eat, drink and go to the toilet okay before you go home.
One parent or carer can usually stay with you the whole time you’re in hospital. There will be a set time when other people can come to visit you during the day.
CONTENT WARNING: See video description
After the surgery you are advised to stick to a soft food diet, which isn’t as bad as it sounds! Ice cream is definitely the best medicine and it’s great for soothing your mouth if it’s sore after the surgery.Laura had an Alveolar Bone Graft operation
Things like soups, mashed potato, yoghurts and smoothies are good as you don’t have to chew them and there are no sharp edges to worry about.
After you go home from the hospital you’ll need around two weeks to rest at home.
The hospital will tell you how often you should take painkillers (medicine which makes your body hurt less) to help you stay comfortable.
You might be given some antibiotic medicine to take at home; this will help to fight any germs in your body and stop infections. If you’re given this medicine, it’s very important that you take it for as long as you need to and don’t skip any doses.
For the first week you’ll probably feel quite tired, and a bit stiff and sore. It’s important for you to spend a lot of time resting so your body can recover. You could spend your time watching a favourite TV show, reading, or doing something else that doesn’t take up too much energy.
In the second week you’ll start to feel better and should find it easier to walk around a little. But don’t try to do too much too soon, and make sure you rest as often as you need to. If you’re feeling up to it, you might be able to catch up on some school work from home.
From the day of your operation you should avoid active exercise or sports for six weeks, including most PE lessons. It takes around six weeks for the bone in your hip to heal, so you don’t want to do too much too soon.
Your mouth has a wound which is still healing, so it’s very important you keep it clean.
You need to brush all of your teeth twice a day with a soft toothbrush and adult toothpaste. You might also be told to use a mouthwash for a week or two, or to gargle with salt water. This keeps your mouth clean.
Your Cleft Team will tell you what kind of stitches you have and what will happen to them while you’re getting better. Most of the time, these are ‘dissolvable’, which means they break up by themselves over time. This doesn’t mean they will all just ‘disappear’, though, and you might notice that you spit out small pieces of your stitches when cleaning your teeth.
You will probably have a big sticky plaster on your hip. This is waterproof to help keep the wound underneath dry.
Your wound will have stitches to keep it closed. Your Cleft Team will tell you what will happen to these.
The hospital will tell you how to look after your hip. It’s important that the wound stays dry, so they will give you advice on washing and looking after the bandage.
You should not go swimming or take a bath during this time.
It can help to wear pyjamas with a loose waist so nothing is pressing against this area while you’re healing. You could also try sleeping with a pillow between your legs for extra support.
You will have a scar on your hip which will fade over time.
You need to eat ‘soft food’, such as soup, yogurt, and mashed potato, for at least two weeks after the operation, and drink lots of water to help your mouth heal.
You might need to stick to soft foods for a little while longer, depending on how you are recovering.
You should avoid ‘hard’ foods like toast, biscuits and crisps. Your Cleft Team will tell you more about the best things to eat and drink after your operation.
We asked some young people who had the ABG operation what their favourite soft foods were. They said:
It can be more comfortable to keep eating soft foods for a while even after you go back to school. You can try adding extra sauce to make your food mushier, and continue to avoid crispy things including crackers or toast.
If you get school meals, your parent or carer can talk to the school to see what they can do. Otherwise, you can make sure there is soft food in your packed lunch.
Everyone is different, but you will usually need two weeks to rest at home before going back to school. This helps to make sure you have enough time to heal.
For the first week you’ll probably feel quite tired, and a bit stiff and sore. It’s important for you to spend a lot of time resting so your body can recover. You could spend your time watching a favourite TV show, reading, or doing something else that doesn’t take up too much energy.
In the second week you’ll start to feel better and should find it easier to walk around a little. But don’t try to do too much too soon, and make sure you rest as often as you need to. If you’re feeling up to it, you might be able to catch up on some school work from home.
Your hip will feel stiff and sore for a little while after your operation. It needs time to recover and get strong again.
You will usually be told to not take part in sports or PE lessons for at least six weeks after your operation.
If you do any sports or activities regularly, talk to your Cleft Team. They will tell you how long you need to wait before going back to these.
Everyone is different, so you may need a little longer before you feel well enough to go back to sports and PE.
You’ll have an appointment with your Cleft Team around two weeks after your operation. They will check how you’re doing and will tell you about what will happen next.
A few months after your operation, the hospital will x-ray your gum to check that everything has gone well.
You might also have appointments with your orthodontist or a special dentist with your cleft team to talk about if you’ll need any other treatment to help with your teeth once you’ve recovered from the operation.
More than 90% of ABG operations are successful. It’s very likely your operation will work just fine.
Sometimes ABG operations don’t work as expected; this can be for lots of reasons. If this happens you might need another ABG operation to make sure there is enough bone in your gum for your adult teeth to grow.
You can help to give the operation the best chance of working by keeping your mouth clean afterwards and doing exactly what the Cleft Team tell you to do.
An infection can happen when germs get into your body and make you feel sick. After your operation you will have a wound in your mouth, which makes it easier for germs to get into your body.
If this happens, the part of your mouth where you had the operation will look more red and swollen. There might be a bad smell coming from your mouth. It will feel like you have the flu or a fever – you will feel hot, you won’t want to eat, and will feel very poorly.
If you think you have an infection, tell your parent or carer straight away so they can tell the Cleft Team.
Keep your mouth really clean after the operation to help stop this from happening.
Most of the time, your mouth will heal just fine and you won’t have any problems. Your gum might swell up while it’s healing, and this is normal.
Your hip will probably be sore for a few weeks after the operation. Sometimes, this side of your leg will feel numb for a while, and this usually gets better.
You should talk to your parent or carer about anything you’re worried about. They can call the Cleft Team for you, or make sure you get an answer at your next hospital appointment.
Cleft++ is a CLAPA service using a specialist online platform to safely connect 10-17-year-olds born with a cleft to a trained mentor. These mentors are young adults born with a cleft and they will draw on their experiences to offer personalised support.
CLAPA Companions is a ‘pen pal’ scheme connecting young people in the UK, born with a cleft aged 6-17 through letters, emails, videos and audio messages.
Talk to your Cleft Team if you need more support for your operation.
