Clinical attachment loss
Clinical attachment loss (CAL) is the predominant clinical manifestation and determinant of periodontal disease.
Anatomy of the attachment
Teeth are attached to the surrounding and supporting alveolar bone by periodontal ligament (PDL) fibers; these fibers run from the bone into the cementum that naturally exists on the entire root surface of teeth. They are also attached to the gingival (gum) tissue that covers the alveolar bone by an attachment apparatus; because this attachment exists superficial to the crest, or height, of the alveolar bone, it is termed the supracrestal attachment apparatus.
The supracrestal attachment apparatus is composed of two layers: the coronal junctional epithelium and the more apical gingival connective tissue fibers. The two layers together form the thickness of the gingival tissue and this dimension is termed the biologic width.
Plaque-induced periodontal diseases are generally classified destructive or non-destructive. Clinical attachment loss is a sign of destructive (physiologically irreversible) periodontal disease.
In gingivitis, inflammation localized to the supracrestal region of the periodontium leads to ulceration of the junctional epithelium. Although this is technically a loss of clinical attachment (because, in health, the epithelium attaches to the surface of the tooth), the term clinical attachment loss is used almost exclusively to refer to connective tissue attachment loss:
Sites with periodontitis exhibit clinical signs of gingival inflammation and loss of connective tissue attachment. Connective tissue attachment loss refers to the pathological detachment of collagen fibers from cemental surface with the concomitant apical migration of the junctional or pocket epithelium onto the root surface.
Periodontology Tissues of the periodontium
and their physiologic entities
Diagnoses Pathogenesis Pathologic entitiesCalculus · Clinical attachment loss · Edentulism · Fremitus · Furcation defect · Gingival enlargement · Gingival pocket · Gingivitis · Horizontal bony defect · Linear gingival erythema · Occlusal trauma · Periodontal pocket · Periodontal disease · Periodontitis · Plaque · Recession · Vertical bony defect Diagnosis, treatment planning,
Periodontal armamentarium Conventional therapy Surgical therapy and
periodontal surgeryApically positioned flap · Bone graft · Coronally positioned flap · Crown lengthening · Open flap debridement · Free gingival graft · Gingivectomy · Guided bone regeneration · Guided tissue regeneration · Implant Placement · Lateral pedicle graft · Pocket reduction surgery · Sinus lift · Subepithelial connective tissue graft
Important personalities Other specialtiesEndodontology · Orthodontology · Prosthodontology
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