Applications of extracellular vesicles in tissue regeneration: a narrative review
Extracellular vesicles (EVs) are nanoscale, membrane-bound particles released by most cell types and play essential roles in intercellular communication. By transporting proteins, lipids, and nucleic acids, they regulate inflammation, angiogenesis, immune responses, and tissue regeneration. Their biocompatibility and ability to deliver targeted molecular cargo make them promising diagnostic and therapeutic tools. In dentistry, EVs support periodontal repair, dentin–pulp regeneration, bone healing, and implant integration. They are also valuable as salivary biomarkers for oral and systemic diseases. Beyond dentistry, EVs are being explored in oncology, cardiovascular repair, neurology, and regenerative medicine as versatile cell-free therapeutic platforms. This review provides a comprehensive overview of the biology, biogenesis, physiological functions, and mechanisms of action of extracellular vesicles, with a particular focus on their emerging applications in tissue regeneration. A literature search was conducted using PubMed and Google Scholar databases for studies published between 2010 and 2025. Original research articles, review papers, and relevant book chapters published in English were included. EVs have emerged as powerful cell-free mediators of regeneration, capable of orchestrating osteogenesis, angiogenesis, immunomodulation, and tissue repair across maxillofacial structures. Their diverse cargo of miRNAs, proteins, and growth factors enables precise modulation of cellular signaling pathways essential for healing. Current evidence highlights their promising applications in periodontal, pulp–dentin, and craniofacial bone regeneration, as well as their diagnostic value through salivary biomarkers. Continued advancements in EVs standardization, large-scale production, and clinical translation will be critical for integrating EVs-based therapies into future regenerative dentistry and maxillofacial medicine.