Periodontal pocket and CAL

1. Pocket and Clinical
attachment loss (CAL)
By: Mohsen Mirkhan
Hawler College of Dentistry
Kurdistan region of Iraq

2. The Periodontal Pocket
The periodontal pocket, defined as a
pathologically deepened gingival
sulcus.
One of the most important clinical
features of periodontal disease.

3. CLASSIFICATION
Pockets can be classified as follows:
1. Gingival pocket (pseudo pocket):
gingival enlargement without destruction
of the underlying periodontal tissues.
2. Periodontal pocket: This type of
pocket occurs with destruction of the
supporting periodontal tissues.

5. Suprabony (supracrestal or supra-alveolar)
Intrabony (infrabony, subcrestal or intra-alveolar)

6. Gingival enlargement with gingival
(pseudo) pocket

7. Simple pocket Compound pocket Complex pocket

9. CLINICAL FEATURES
• Bluish-red and thickened marginal gingiva.
• Gingival bleeding, suppuration, or both.
• Tooth mobility.
• Diastema formation.
• Localized pain or pain "deep in the bone“.

13. Pocket Contents
Periodontal pockets contain:
• Microorganisms and their products (enzymes,
endotoxins, and other metabolic products).
• Gingival fluid
• Food remnant
• Salivary mucin
• Desquamated epithelial cells, and leukocytes.
• Plaque-covered calculus
• Purulent exudate, if present, consists of living,
degenerated, and necrotic leukocytes.
• Serum and a scant amount of fibrin.

14. Clinical Attachment Loss
• Clinical attachment loss is defined
as the extent of the periodontal
support that has been destroyed
around a tooth.
• In health, one might assume that
this should be expressed as zero
millimeters

15. Probing depth measurement: 6 mm
Gingival margin level: 0 mm*
Clinical attachment loss: 6 mm

16. Probing depth measurement: 4 mm
Gingival margin level: +2 mm
Clinical attachment loss: 6 mm

17. Probing depth measurement: 9 mm
Gingival margin level: -3 mm*
Clinical attachment loss: 6 mm