Calculating Clinical Attachment Level by Bronte D.



hi everyone my name is Bronte d'arco and today we're going to be discussing the topic of calculating clinical attachment level now measuring clinical attachment level is one of the eight advanced probing techniques along with assessing oral lesions measuring gingival recession and also measuring tooth mobility among many other things so measuring clinical attachment level is actually a very crucial part to the overall periodontal assessment process so it is crucial for all hygienists to know how to accurately measure clinical attachment level now there are some minor calculations required it is very simple process but I did create a PowerPoint presentation for everybody hopefully that will help simplify the process and I have no doubt that you guys will be successful so let's get started okay so again we are going to be learning about advanced probing techniques specifically calculating clinical attachment level okay so let's review today's learning objective following this lesson the student will accurately calculate the clinical attachment level of any given tooth so hopefully after today's PowerPoint presentation everyone will be comfortable enough to do so okay so what is clinical attachment level clinical attachment level or cow or CA L is the approximate position of periodontal attachment of a tooth and that is measured by the periodontal probe so essentially what we're looking for when we're measuring clinical attachment level is how much periodontal support a given tooth has so a very important thing to note here is that clinical attachment levels are always calculated from measurements made from a fixed point the cement to enamel Junction or cej and as you can see I've notated on this image an arrow that marks the cej and this is where the enamel and the cementum of a tooth meet there are two measurements used to calculate the clinical attachment level number one is the probing depth and everyone should be comfortable enough to do so at this point as you can see in the picture on the left hand side the measurement is about six millimeters deep and number two we're checking for the level of the gingival margin and what that measurement is is the distance between the Cee Cee Jay and the gingival margin and as you can see in this image it is about five millimeters in depth Cal is like a basic math problem it's actually quite simple CA l equals probe depth measurement plus or minus gingival margin level and I say plus or minus because it depends on the level of attachment remember the gingival margin level may be at above or below the cej so let's start with a simple example in this image as you can see here the probe depth measurement is about six millimeters deep and as you can see by the arrow the gingival margin level is at the cej it is not above or below so in this case there's no math that needs to be done because it's zero millimeters where the gingival margin meets so there's an overall clinical attachment loss of six millimeters so that's how you find your CA L so let's do another example as you can see in the image there's a four millimeters of probe depth measurement and also as depicted by the arrow you can see that there are two millimeters of general recession that means that the gumline is below the cej by two millimeters so since we are trying to calculate the total amount of clinical attachment loss we're going to add the four millimeters from the probe depth measurement plus the two millimeters of the gingival margin level and that's going to equal six millimeters of total clinical attachment loss so example number three here shows a probe depth measurement of nine millimeters deep and the gingival margin level is three millimeters above the gumline so what that means is that the CA L will be six millimeters deep and how we got that measurement is by taking the nine millimeters of probe depth measurement and subtracting the X three millimeters of gum tissue that's above the cej and again that leads us to six millimeters so let's do a quick clinical scenario let's say that tooth number three presents with five millimeters of gingival recession and that you measure a probe depth measurement on the direct buccal to be three millimeters deep so what is the clinical attachment level so it's very similar to example number two where the patient presented with some gingival recession what we do is we take the three millimeters of probe depth measurement and add the five millimeters of general recession and that gives us a total of eight millimeters of clinical attachment loss so let's do a brief review clinical attachment level calculates the approximate amount or level of periodontal support finding the relationship of the gingival tissue to the cej is key remember it can either be at above or below the cej hygienists must find the probing depth and the level of the gingival margin in order to calculate clinical attachment level properly and the final calculation to go over is that Cal equals probe depth measurement plus or minus gingival margin level so did we meet today's learning objective well let's review that again briefly following this lesson the student will accurately calculate the clinical attachment level of any given tooth now I would say that we've done a very good job at doing so today we have gone over a handful of wonderful clinical examples so I believe that we have met today's learning objective now if anybody has any questions or concerns of course you're always free to contact me at any time here is a brief list of the references that I use today so all that I have for you guys today I hope that you found this lesson to be very helpful to you if you have any questions or concerns please contact me and I hope you have a great rest of your day thank you

7 comments

  1. Hi, I’m wondering what the numbers mean exactly in relation to how well the tooth is supported through the structures? Will having a larger clinical attachment # mean that the tooth isn’t well supported then? Just looking for clarification to better understand CAL! Thank you!

  2. Very nice video, I always confused 🤷‍♀️ how to calculate CAL level. Now I confidently say I noe the concept behind it. Gr8 make more videos.
    Please make a video on periodontal charting.Thank you

  3. Considering that the new AAP staging refers to interdental CAL not direct buccal or lingual – when will you address this?

  4. very helpful thank you very much!! but regarding the clinical scenario question why did we add when they didn't mention if its a negative or a positive type of recession?

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