The gomphosis is the specialized fibrous joint between each tooth root and its alveolar socket in the maxilla or mandible, mediated by the periodontal ligament (PDL). It is the only gomphosis in the human body, defined as a peg-and-socket fibrous joint. The tooth root (peg) is held within the alveolar socket by the PDL collagen fibres, which run obliquely from the cementum to the alveolar bone in a configuration that suspends the tooth and allows micro-movements of 25-100 micrometres under occlusal load.
The gomphosis is the fundamental joint of dentistry. Periodontal disease destroys the PDL and supporting alveolar bone, progressively loosening the gomphosis until tooth loss. Orthodontic tooth movement exploits the viscoelastic properties of the gomphosis: sustained pressure applied to a tooth remodels the PDL and alveolar bone on the pressure side (resorption) and tension side (apposition), moving the tooth root through bone. Dental implants lack a gomphosis (they are osseointegrated directly into bone without a PDL), which is why they feel different under load and cannot be moved orthodontically.
Dental trauma from direct impact partially or completely displaces the tooth within its gomphosis, injuring the PDL fibres from concussion (no displacement) through subluxation, lateral luxation, extrusion, intrusion, and avulsion; PDL viability is the critical factor in prognosis for reimplanted avulsed teeth, and immediate reimplantation within 30 minutes (ideally in Hanks balanced salt solution) maximises PDL cell survival.
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