Clinical Attachment Loss Case Study

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Clinical attachment loss (CAL)

Definition:

• The distance from CEJ to the tip of a periodontal probe during usual periodontal diagnostic probing.
• When CEJ is not detectable or missing, the CAL is measured from a a fixed reference point (margin of restoration or incisal / occlusal edge of the tooth. This is called Relative Attachment Level.

*CAL is a calculation of Pocket Depth and Gingival Margin: CAL=PD+GM.
-The CAL rating reflects the overall risk of losing the tooth.
-The higher the CAL number, the greater the chance of losing the tooth.

*The AAP also provides us with the guidelines for classifying our patients’ periodontal status.

1 to 2 mm CAL = Slight
3 to 4 mm CAL = Moderate 5 to 6 mm …show more content…
**OR** Clinical attachment LOSS is 2mm.

*Both statements mean the patient has had 2mm of their periodontal attachment destroyed. The terms are used interchangeably and are treated the same way.

*Periodontitis is diagnosed when a there is progression of attachment loss, requiring documentation of increased CAL between at LEAST two time points.
.

- Evaluating CAL is critical for deciphering between active periodontitis and gingivitis on a reduced but stable periodontium.
-Measuring PD alone can result in unnoticed progression of CAL

* CAL is calculated from a fixed reference point (cementoenamel junction or CEJ), and it is computed by calculating the distance from the CEJ to the base of the pocket. When the gingival margin is coronal to the CEJ, you subtract (from the probing depth) the distance from the CEJ to the gingival margin. If the gingival margin is apical to the CEJ, CAL is equal to the probing depth plus the distance from the CEJ to the gingival margin.

* Calculating CAL in the presence of Recession of the Gingival Margin
When recession of the gingival margin is present, the CAL is calculated by adding the probing depth to the gingival margin …show more content…
When some patients have medication-induced gingival enlargement, for example, probing depths on their own overestimate CAL. Periodontal probing, by itself, is not a reliable measurement, since many variables can cause measurement error while probing.

*Pocket formation causes loss of attachment of the gingiva and denudation of the root surface. The severity of the attachment loss is generally, but not always, corre-lated with the depth of the pocket. This is because the degree of attachment loss depends on the location of the base of the pocket on the root surface, whereas the pocket depth is the distance between the base of the pocket and the crest of the gingival margin. Pockets of the same depth may be associated with different degrees of attachment loss, and pockets of different depths may be associated with the same amount of at-tachment loss

Reference : *
. Michalowicz BS, Hodges JS, Pihlstrom BL. Is change in probing depth a reliable predictor of change in clinical attachment loss
Clinical Periodontology – Carranza 10th
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