Possible protective effects of the Bmal1 gene and melatonin on the prognosis of apical periodontitis

Abstract

Apical periodontitis (AP) is defined as inflammation of the tissues surrounding the root apex and presents many challenges for successful endodontic treatment. The presence of microorganisms and other irritants in the root canal system, as well as the host defence mechanism, play a crucial role in the development of AP. Although the root canal procedure is commonly recommended as a standard first-line treatment with a high success rate, a successful outcome cannot always be guaranteed in cases of AP. Another important factor to consider is the integrity of the immune system is essential for defence against infectious microorganisms and their by-products. The functional modulation of the immune system by various methods, such as therapeutic, nutritional, and prophylactic approaches, continues to be an important focus of attention. However, the influence of these mechanisms on AP has not yet been fully understood. The main circadian clock controls most of the metabolic and pathophysiological processes in the human body. The brain and muscle Arnt-like protein-1 (Bmal1), one of the circadian clock genes, regulates the cellular events of the immune system in oral tissues. Additionally, melatonin controls the expression of the Bmal1 clock gene by activating the phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) signalling pathway. Therefore, this hypothetical study set out to assess whether the melatonin hormone might significantly reduce the severity of AP by creating differences in the cellular responses of the immune system through the Bmal1 clock gene. In light of this brief review, it is determined that both the Bmal1 clock gene and melatonin should be considered in the treatment process and prognosis of AP.