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@article{208318,
        author = {Dr. Deepshika Saravanan and Dr. Abarnashree.A.S and Dr. Joshua Samuel and Dr. Chandini Parveen},
        title = {Exosomes in cell free regenerative therapies: mechanistic promise, clinical silence},
        journal = {International Journal of Innovative Research in Technology},
        year = {2026},
        volume = {13},
        number = {4},
        pages = {1377-1386},
        issn = {2349-6002},
        url = {https://ijirt.org/article?manuscript=208318},
        abstract = {Regenerating a fully functional periodontium is one of the central challenges in periodontology, requiring the simultaneous, coordinated restoration of alveolar bone, periodontal ligament, cementum, and a stable connective-tissue attachment — all within a wound environment that remains chronically inflamed. Exosomes which are a subset of small extracellular vesicles of endosomal origin, have attracted attention as cell-free therapeutic tools capable of transferring proteins, lipids, and regulatory RNA between cells and reproducing the paracrine effects of mesenchymal stem/stromal cells without the risks associated with transplanting living cells. Dental stem cells — including periodontal ligament stem cells, dental pulp stem cells, stem cells from human exfoliated deciduous teeth, stem cells from the apical papilla, dental follicle progenitors, and gingival mesenchymal stem cells — serve as biologically relevant sources of such exosomes. In periodontal research, exosomes have been shown to support periodontal ligament cell migration and proliferation, osteogenesis, angiogenesis, fibroblast regulation, and immune modulation, and can be incorporated into hydrogels or three-dimensional scaffolds for delivery to intrabony or furcation defects. Despite this preclinical enthusiasm, evidence in humans remains almost entirely absent: to date, no completed clinical trial has evaluated exosomes-based therapy for periodontal regeneration, and only isolated case reports and early-phase or ongoing trial registrations exist. Clinical translation is further constrained by variability in exosomes source and isolation methodology, non-standardised dosing, storage and stability limitations, incomplete potency testing, unresolved safety and manufacturing/scale-up concerns, and questionable cost-effectiveness relative to established regenerative techniques such as guided tissue regeneration. This review covers the biology and isolation of exosomes; their classification among extracellular vesicles, with reference to MISEV reporting guidelines; their mechanisms of action; present and future applications in periodontal regeneration and related periodontal therapies; the reasons underlying the current gap in clinical translation; and the developmental milestones exosomes-based therapies must reach to approach the level of clinical adoption achieved by cell-based therapeutics.},
        keywords = {exosomes; extracellular vesicles; periodontal regeneration; cell-free therapy; periodontal ligament stem cells; guided tissue regeneration; enamel matrix derivative; platelet-rich fibrin},
        month = {September},
        }