Anatomy of the attachment - Teeth are attached to alveolar bone by periodontal ligament (PDL) fibers - PDL fibers run from bone into cementum on root surface of teeth - Teeth are also attached to gingival tissue that covers alveolar bone - Attachment apparatus exists superficial to crest of alveolar bone - Supracrestal attachment apparatus is composed of coronal junctional epithelium and gingival connective tissue fibers

Periodontal disease - Plaque-induced periodontal diseases are classified as destructive or non-destructive - Clinical attachment loss is a sign of destructive periodontal disease - Clinical attachment loss refers to connective tissue attachment loss - Sites with periodontitis show signs of gingival inflammation and connective tissue attachment loss - Connective tissue attachment loss involves detachment of collagen fibers from cemental surface

Biologic width - Biologic width refers to the thickness of gingival tissue - Biologic width is formed by coronal junctional epithelium and gingival connective tissue fibers - Biologic width is an important dimension in the attachment apparatus - Biologic width is measured from the crest of alveolar bone to the base of the gingival sulcus - Maintaining proper biologic width is crucial for periodontal health

Clinical attachment loss - Clinical attachment loss is a term used to describe connective tissue attachment loss - It is a sign of destructive periodontal disease - Clinical attachment loss involves apical migration of junctional or pocket epithelium - Collagen fibers detach from cemental surface during clinical attachment loss - Clinical attachment loss is associated with progression of periodontitis

References - Itoiz, ME; Carranza, FA: The Gingiva. In Newman, MG; Takei, HH; Carranza, FA; editors: Carranzas Clinical Periodontology, 9th Edition, Philadelphia: W.B. Saunders Company, 2002, pages 26-7 - Armitage, GC - Capnocytophaga sp. - Preston D. Miller - Willoughby D. Miller