How is the Clinical Attachment Level (CAL) determined?

The Clinical Attachment Level (CAL) is determined by assessing both the probing depth and the position of the gingival margin relative to the cementoenamel junction (CEJ). CAL provides a crucial measurement for understanding periodontal attachment and health.

To calculate CAL, you take the probing depth and add or subtract the distance from the gingival margin to the CEJ. If the gingival margin is apical to the CEJ, you add that measurement to the probing depth. Conversely, if the gingival margin is coronal to the CEJ, you subtract that distance from the probing depth. This method incorporates both the depth of the periodontal pocket and the position of the gums, providing a comprehensive view of periodontal attachment levels.

Other methods listed, such as measuring directly from the CEJ to the base of the pocket or solely relying on probing depth, do not account for the varying positions of the gingival margin, which can lead to inaccurate assessments of periodontal health. Additionally, obtaining CAL from X-ray examinations is not a reliable approach, as radiographs do not provide direct measurements of the gingival margin or probing depth. Thus, the most accurate method for determining Clinical Attachment Level is based on the combination of probing depth and gingival margin position.