How is CAL calculated when there is hyperplasia?

• A. Probe depth + tissue coronal to CEJ
• B. Probe depth - tissue coronal to CEJ
• C. Probe depth - gingival recession
• D. Probe depth + gingival recession

Answer: (B)

CAL is the distance from the CEJ to the base of the pocket. When hyperplasia moves the gingival margin coronally (toward the crown) relative to the CEJ, you subtract that coronal displacement from the probing depth to get CAL.

For example, if probing depth is 3 mm and the gingival margin sits 1 mm coronal to the CEJ, CAL = 3 − 1 = 2 mm. If the margin were at or apical to the CEJ (recession), you’d add the recession distance instead.