Clinical Attachment Level
Also written as: CAL — Clinical Attachment Level
A periodontal measurement from the cementoenamel junction to the base of the pocket, combining probing depth with any recession or pseudo-pocketing present.
Full Definition
Clinical attachment level (CAL), also called clinical attachment loss when describing disease progression, is the distance from the cementoenamel junction (CEJ) to the base of the periodontal pocket. Unlike probing depth, which measures from the gingival margin, CAL is corrected for recession or coronal migration of the gingival margin and therefore provides a more accurate representation of the true extent of connective tissue destruction. It is the primary outcome measure in most periodontal clinical trials and is required in disease classification under the 2017 World Workshop staging and grading system. Editors should ensure 'CAL' and 'PD' are not used interchangeably, as doing so constitutes a clinical error.
Usage
Usage note: When reporting disease, prefer 'clinical attachment loss' (the change) over 'clinical attachment level' (the static measure) unless the latter is explicitly intended.
In Context
- "A clinical attachment level of ≥2 mm at two or more non-adjacent teeth is required for a diagnosis of generalised periodontitis." — Clinical research article
- "The manuscript incorrectly used 'probing depth' and 'clinical attachment level' as synonyms; these must be corrected throughout." — Peer review comment