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
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- Preston D. Miller
- Willoughby D. Miller