Exosome-based strategies for periodontal regeneration: Current insights and future prospects (Review)

The tooth-supporting structures gradually deteriorate due to periodontal disease and standard regenerative therapies are currently being modified using adjunctive strategies to optimise the treatment outcomes. Nanosized extracellular vesicles called exosomes, which contain bioactive molecules, function as mediators of immunomodulation, regeneration, and tissue repair. Recent research indicates that exosomes may enhance periodontal regeneration through immunomodulation, osteogenesis and angiogenesis from various stem cells. It is suggested that exosomes promote fibroblast proliferation, reduce inflammation and accelerate bone/cementum regeneration. Scaffold-loaded exosomes provide sustained release. The purpose of the present review was to discuss the functions of exosomes and their potential to be used as therapeutic agents in periodontal regeneration. For this purpose, the terms 'Exosomes', 'Extracellular Vesicles' and 'Periodontal Regeneration' were searched in Google Scholar, Web of Science and PubMed databases to identify articles in the English language published up to June, 2025. Grey literature was searched through an internet-based free tool created by the Canadian Agency for Drugs and Technologies in Health. Two independent reviewers evaluated the titles and abstracts of the retrieved studies, followed by a detailed review of the full texts to extract information relevant to the research objective. While further clinical research is required to validate their regenerative potential, the evidence generally points to exosomes as promising therapeutic agents. Although the available data are encouraging, standardized procedures and clinical trials are required before they can be routinely used in clinical settings, to address challenges with delivery and isolation.