Clinical attachment loss: Difference between revisions

Latest revision as of 19:06, 22 March 2025

Loss of connective tissue attachment in periodontitis

Clinical attachment loss (CAL) refers to the pathological detachment of the periodontal ligament from the tooth surface, resulting in the apical migration of the junctional epithelium and the loss of alveolar bone. It is a critical indicator of periodontal disease progression and is used to assess the severity of periodontitis.

Pathophysiology[edit]

Clinical attachment loss occurs when the supporting structures of the teeth, including the gingiva, periodontal ligament, and alveolar bone, are destroyed due to inflammatory processes. This destruction is primarily caused by the host's immune response to bacterial plaque accumulation on the teeth. The inflammation leads to the breakdown of collagen fibers in the periodontal ligament and the resorption of alveolar bone, resulting in the detachment of the tooth from its supporting structures.

Measurement[edit]

The extent of clinical attachment loss is measured using a periodontal probe. The probe is inserted into the gingival sulcus to measure the distance from the cementoenamel junction (CEJ) to the base of the pocket. This measurement is recorded in millimeters and indicates the amount of attachment loss. A higher measurement signifies more severe attachment loss and periodontal disease.

Clinical Significance[edit]

Clinical attachment loss is a key diagnostic criterion for periodontitis. It helps in classifying the disease into different stages and grades, which are essential for determining the appropriate treatment plan. The presence of clinical attachment loss differentiates periodontitis from gingivitis, which is characterized by inflammation without attachment loss.

Management[edit]

The management of clinical attachment loss involves controlling the underlying periodontal disease. This includes:

Scaling and root planing to remove plaque and calculus from the tooth surfaces and root.
Periodontal surgery to reduce pocket depths and regenerate lost periodontal structures.
Antibiotic therapy to control bacterial infection.
Maintenance therapy to prevent further attachment loss through regular dental check-ups and oral hygiene practices.

Prevention[edit]

Preventing clinical attachment loss involves maintaining good oral hygiene to prevent the accumulation of bacterial plaque. This includes:

Regular tooth brushing and flossing.
Professional dental cleanings.
Use of antimicrobial mouth rinses.
Lifestyle modifications such as smoking cessation and managing systemic conditions like diabetes.

Related pages[edit]

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-{{refimprove|date=January 2012}}
+{{Short description|Loss of connective tissue attachment in periodontitis}}
-'''Clinical attachment loss''' ('''CAL''') is the predominant clinical manifestation and determinant of [[periodontal disease]].
-==Anatomy of the attachment==
+'''Clinical attachment loss''' (CAL) refers to the pathological detachment of the [[periodontal ligament]] from the [[tooth]] surface, resulting in the apical migration of the [[junctional epithelium]] and the loss of [[alveolar bone]]. It is a critical indicator of [[periodontal disease]] progression and is used to assess the severity of [[periodontitis]].
-Teeth are attached to the surrounding and supporting alveolar bone by [[periodontal fiber|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 [[gingiva|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 [[Commonly used terms of relationship and comparison in dentistry|coronal]] [[junctional epithelium]] and the more [[Commonly used terms of relationship and comparison in dentistry|apical]] [[gingival fibers|gingival connective tissue fibers]].<ref name="Itoiz">Itoiz, ME; Carranza, FA: The Gingiva.  In Newman, MG; Takei, HH; Carranza, FA; editors: ''Carranza’s Clinical Periodontology'', 9th Edition. Philadelphia: W.B. Saunders Company, 2002. pages 26-7.</ref>  The two layers together form the thickness of the gingival tissue and this dimension is termed the ''[[biologic width]]''.
+==Pathophysiology==
+Clinical attachment loss occurs when the supporting structures of the teeth, including the [[gingiva]], [[periodontal ligament]], and [[alveolar bone]], are destroyed due to inflammatory processes. This destruction is primarily caused by the host's immune response to [[bacterial plaque]] accumulation on the teeth. The inflammation leads to the breakdown of collagen fibers in the periodontal ligament and the resorption of alveolar bone, resulting in the detachment of the tooth from its supporting structures.
-<youtube>
+==Measurement==
-title='''Documentary Film - {{PAGENAME}}'''
+The extent of clinical attachment loss is measured using a [[periodontal probe]]. The probe is inserted into the [[gingival sulcus]] to measure the distance from the [[cementoenamel junction]] (CEJ) to the base of the pocket. This measurement is recorded in millimeters and indicates the amount of attachment loss. A higher measurement signifies more severe attachment loss and periodontal disease.
-movie_url=http://www.youtube.com/v/L-fYRfvdyG4
-&rel=1
-embed_source_url=http://www.youtube.com/v/L-fYRfvdyG4
-&rel=1
-wrap = yes
-width=750
-height=600
-</youtube>
-==Periodontal disease==
+==Clinical Significance==
-Plaque-induced periodontal diseases are generally classified destructive or non-destructive.  Clinical attachment loss is a sign of destructive (physiologically irreversible) periodontal disease.
+Clinical attachment loss is a key diagnostic criterion for [[periodontitis]]. It helps in classifying the disease into different stages and grades, which are essential for determining the appropriate treatment plan. The presence of clinical attachment loss differentiates periodontitis from [[gingivitis]], which is characterized by inflammation without attachment loss.
-The term clinical attachment loss is used almost exclusively to refer to connective tissue attachment loss:https://medical-dictionary.thefreedictionary.com/loss+of+attachment
+==Management==
+The management of clinical attachment loss involves controlling the underlying periodontal disease. This includes:
+* [[Scaling and root planing]] to remove plaque and calculus from the tooth surfaces and root.
+* [[Periodontal surgery]] to reduce pocket depths and regenerate lost periodontal structures.
+* [[Antibiotic therapy]] to control bacterial infection.
+* [[Maintenance therapy]] to prevent further attachment loss through regular dental check-ups and oral hygiene practices.
-{{quotation|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.<ref name="Armitage">Armitage, GC. <u>Clinical evaluation of periodontal disease</u>. ''Perio 2000'' 1995;7:39-53</ref>|sign=|source=}}
+==Prevention==
+Preventing clinical attachment loss involves maintaining good oral hygiene to prevent the accumulation of bacterial plaque. This includes:
+* Regular [[tooth brushing]] and [[flossing]].
+* Professional dental cleanings.
+* Use of [[antimicrobial mouth rinses]].
+* Lifestyle modifications such as smoking cessation and managing systemic conditions like [[diabetes]].
-==References==
+==Related pages==
-{{Reflist}}
+* [[Periodontitis]]
+* [[Gingivitis]]
+* [[Periodontal ligament]]
+* [[Alveolar bone]]
+* [[Dental plaque]]
-{{Periodontology}}
+[[Category:Periodontology]]
-[[Category:Dentistry]]