الفهرس 
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Abstract
Summary and conclusion
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These results were confirmed with Masson’s trichrome stain, where the collagen fibers showed weakly positive reactivity representing the degenerative effect of tramadol.
On the other hand, the alveolar bone of the tramadol-treated animals showed increased osteoclastic activity as multinucleated osteoclasts were identified within their lacuna along the alveolar process borders making them eroded. Several reversal lines were also observed donating high turnover rate. Wide hypermic bone marrow cavities were also observed.
Tramadol withdrawal animals shows improvement to great extent. In the PDL, the collagen fibers mostly regained their arrangement and association. Dilatation of the blood vessel was still observed but to a lesser degree.
In the alveolar bone, less osteoclastic activity and less reversal lines were observed indicating turnover rate close to the normal. PDL/ alveolar bone interface appeared to be smooth with areas of newly formed osteoid tissue, as the later representing regeneration.
Masson’s trichrome stain confirmed the Hx. & E. results as collagen fibers of both PDL and alveolar bone showed moderately positive reactivity to the stain.
Immunohistochemical results:
Immunoperoxidase for demonstration of fibronectin:
Collagen fibers and fibroblasts of the PDL of tramadol treated animals showed negative to weakly positive reactivity to immunoperoxidase staining for fibronectin localization, while osteocytes and bone marrows in the alveolar bone showed weakly positive reactivity. These results represented the decrease
Summary and conclusion
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of the fibronectin content in both tissues. On the other hand, tramadol withdrawal animals showed increase in the fibronectin content as the collagen fibers and fibroblasts of PDL and osteocytes and bone marrows of the alveolar bone showed moderately positive reactivity to immunoperoxidase staining for fibronectin localization.
P53 immunostaining:
This staining procedure was performed to detect apoptosis, where tramadol treated animals showed strongly positive reactivity of the nuclei of both fibroblasts and osteocytes in the PDL and alveolar bone, respectively. On the other hand, tramadol withdrawal animals showed weakly positive reactivity of the fibroblasts and osteocytes. This indicates the increase in the apoptotic activity with tramadol long term use.
Conclusion
According to the results of the present investigation, the following points could be concluded:
Long term administration of high doses of tramadol hydrochloride has harmful effect on PDL and alveolar bone.
Dissociation, disarrangement and detachment of the PDL fibers and increased the osteoclastic activity and reversal lines in the alveolar bone are the main features of tramadol degenerative effects on PDL and alveolar process.
Fibronectin content in both PDL and alveolar bone decreases after daily use of tramadol for three months.
Apoptosis is increased secondary to long term use of high doses of oral tramadol.
Summary and conclusion
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The degenerative effects of tramadol hydrochloride are reversible as on tramadol withdrawal the tissues of PDL and alveolar bone partially regain their normal picture.