Clinical Attachment Level

CLINICAL ATTACHMENT LEVEL

CALs are calculated from measurements made from a fixed point that does not change - the CEJ (cemento-enamal junction).

A healthy bone level is approximately 2mm apical to the CEJ.

CALs provide a reliable indication of the extent of bone support for a tooth.

Today's Agenda

1. Define "Clinical attachment level/loss"

2. Learn the 3 different types of clinical attachment levels

3. Calculate CAL

Calculating CAL when the gingival margin is at the CEJ.

There are no calculations required when the gingival margin is level to the CEJ because the probing depth and the CAL are equal.

For example:

Probing depth measurement: 6mm

Gingival margin level: 0mm

Clinical attachment loss: 6mm

Clinical Attachment Level (CAL)

- refers to the estimated position of the structures that support the tooth as much as measured with a periodontal probe

- provides an estimate of a tooth's stability and the loss of bone support

Two terms are commonly used in conjunction with the periodontal support system:

-> CLINICAL ATTACHMENT LEVEL and

-> CLINICAL ATTACHMENT LOSS (which is the extent of periodontal support that has been destroyed around a tooth).

Both of these terms may be abbreviated as CAL and can be used synonymously

Calculating CAL in the presence of gingival recession

When recession is present, the CAL is calculated by ADDING the probing depth to the gingival margin level.

Calculating CAL when the gingival margin covers the CEJ

For example:

Probing depth measurement: 4mm

Gingival margin level: +2mm

Clinical attachment loss: 6mm

When the gingival margin is coronal to the CEJ, the CAL is calculated by SUBTRACTING the gingival margin level from the probing depths.

For example:

Probing depth measurement: 9mm

Gingival margin level: -3mm

Clinical attachment loss: 6mm

Calculating CAL

The most common calculations are the CAL and the WIDTH OF THE ATTACHED GINGIVA.

A competent clinician must understand the procedure for determining the CAL for the three possible relationships of the gingival margin and the CEJ.

1. Gingival margin at the Cemento-Enamel Junction (CEJ)

The gingival margin is at the CEJ which is its natural position.

2. Gingival margin significantly covers the CEJ.

3. Gingival margin significantly apical to the CEJ.

Level of the gingival margin

Known as RECESSION, this relationship leads to the exposure of the root surface.

The gingival margin is significantly coronal to the CEJ and covers a portion of the tooth crown.

Causes: - edema (swelling)

- overgrowth from medications

- long-standing inflammation of the tissue

The level of the gingival margin can change over time in response to TRAUMA, MEDICATIONS, or DISEASE.

Three possible relationships exist between the gingival margin and the cemento-enamel junction (CEJ) of the tooth:

Now, put your knowledge to the test....