Clinical Attachment Level
Also written as: CAL — Clinical Attachment Level
The distance from the cementoenamel junction to the base of the periodontal pocket, used as a definitive measure of periodontal tissue loss.
Full Definition
Clinical attachment level (CAL) is the standard research metric for quantifying the true extent of periodontal destruction, as it references the fixed anatomical landmark of the cementoenamel junction (CEJ) rather than the moveable gingival margin. CAL is calculated by combining the probing depth with the distance from the CEJ to the gingival margin (positive when recession is present, negative when the margin is coronal to the CEJ). In dental research publications, CAL is distinguished from periodontal probing depth (PPD); editors should flag any manuscript that conflates or substitutes these two terms. CAL values are used in case definitions for periodontitis staging under the 2017 World Workshop classification.
Usage
Usage note: Always expand on first use as 'clinical attachment level (CAL)'. Do not use 'attachment loss' and 'CAL' interchangeably without explanation, as 'attachment loss' implies a change over time.
In Context
- "Stage III periodontitis was defined as CAL ≥ 5 mm with tooth loss attributable to periodontitis." — Case definition in a cohort study
- "The authors should clarify whether CAL or PPD was the primary outcome, as the two terms are used interchangeably in the results." — Peer-review editorial comment