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The definition of CAL is the distance from the cementoenamel junction (CEJ) to the tip of a periodontal probe during diagnostic periodontal probing.¹ The amount of gingival recession is needed to calculate the CAL. Recession by definition is the migration of the gingiva to a point apical to the CEJ,¹ and it is often described as the distance between CEJ and the free gingival margin. Recession can be recorded as a positive (+) or negative (–) measurement. Recession is recorded as “+” when CEJ is visible and the free gingival margin is below the CEJ. However, when there is gingival enlargement, recession is recorded as a negative “–” measurement (Fig 2-1). CAL can then be calculated by adding PD and recession (making sure to include “+” or “–”). In Fig 2-1, all four case scenarios measured 6 mm PD; however, when recession is taken into account to determine the CAL, it is clear that the degree of periodontal destruction of these four cases is very different. Therefore, compared with PD, the level of CAL can provide a better overall estimate of the periodontium, and it usually correlates better with radiographic bone loss.³

Fig 2-1 Representation of different situations with 6 mm PD and different attachment levels. Rec, recession.