Exosomes are the smallest subset of extracellular signaling vesicles secreted by most cells with the ability to communicate with other tissues and cell types over long distances. Their use in regenerative medicine has gained tremendous momentum recently due to their ability to be utilized as therapeutic options for a wide array of various diseases. Over 5000 publications are currently being published on this topic yearly, many of which in the dental space. This extensive review article is the first scoping review aimed at summarizing all therapeutic uses of exosomes in regenerative dentistry. A total of 944 articles were identified as using exosomes in the dental field for either their regenerative/therapeutic potential or for diagnostic purposes derived from the oral cavity. In total, 113 research articles were selected for their regenerative potential (102 in vitro, 60 in vivo, 50 studies included both). Therapeutic exosomes were most commonly derived from dental pulps, periodontal ligament cells, gingival fibroblasts, stem cells from exfoliated deciduous teeth, and the apical papilla which have all been shown to facilitate the regenerative potential of a number of tissues including bone, cementum, the periodontal ligament, nerves, aid in orthodontic tooth movement, and relieve temporomandibular joint disorders, among others. Results demonstrate that the use of exosomes led to positive outcomes in 100% of studies. In the bone field, exosomes were found to perform equally as well or better than rhBMP2 while significantly reducing inflammation. Periodontitis animal models were treated with simple gingival injections of exosomes and benefits were even observed when the exosomes were administered intravenously. Exosomes are much more stable than growth factors and were shown to be far more resistant against degradation by periodontal pathogens found routinely in a periodontitis environment. Comparative studies in the field of periodontal regeneration found better outcomes for exosomes even when compared to their native parent stem cells. In total 47 diagnostic studies revealed a role for salivary/crevicular fluid exosomes for the diagnosis of birth defects, cardiovascular disease, diabetes, gingival recession detection, gingivitis, irritable bowel syndrome, neurodegenerative disease, oral lichen planus, oral squamous cell carcinoma, oropharyngeal cancer detection, orthodontic root resorption, pancreatic cancer, periodontitis, peri‐implantitis, Sjögren syndrome, and various systemic diseases. Hence, we characterize the exosomes as possessing “remarkable” potential, serving as a valuable tool for clinicians with significant advantages.

中文翻译：

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了解外泌体：第 3 部分——牙科的治疗+诊断潜力


外泌体是大多数细胞分泌的细胞外信号小泡的最小子集，能够与其他组织和细胞类型长距离通讯。由于它们能够用作多种疾病的治疗选择，它们在再生医学中的应用最近获得了巨大的发展势头。目前每年有超过 5000 篇关于该主题的出版物出版，其中许多是牙科领域的。这篇广泛的综述文章是第一篇范围界定综述，旨在总结外泌体在再生牙科中的所有治疗用途。总共有 944 篇文章被确定在牙科领域使用外泌体，以实现其再生/治疗潜力或用于口腔诊断目的。总共有 113 篇研究文章因其再生潜力而入选（102 篇体外研究，60 篇体内研究，50 篇研究同时包含两者）。治疗性外泌体最常见地来源于牙髓、牙周膜细胞、牙龈成纤维细胞、脱落乳牙的干细胞和根尖乳头，这些细胞均已被证明可以促进包括骨、牙骨质、牙周组织在内的许多组织的再生潜力。韧带、神经，帮助正畸牙齿移动，缓解颞下颌关节紊乱等。结果表明，外泌体的使用在 100% 的研究中取得了积极的结果。在骨领域，外泌体被发现与 rhBMP2 表现相同或更好，同时显着减少炎症。通过简单的牙龈注射外泌体来治疗牙周炎动物模型，甚至在静脉注射外泌体时也观察到了益处。 外泌体比生长因子稳定得多，并且对牙周炎环境中常见的牙周病原体的降解具有更强的抵抗力。牙周再生领域的比较研究发现，即使与天然亲本干细胞相比，外泌体也能产生更好的结果。总共 47 项诊断研究揭示了唾液/龈沟液外泌体在诊断出生缺陷、心血管疾病、糖尿病、牙龈退缩检测、牙龈炎、肠易激综合征、神经退行性疾病、口腔扁平苔藓、口腔鳞状细胞癌、口咽癌方面的作用检测、正畸牙根吸收、胰腺癌、牙周炎、种植体周围炎、干燥综合征以及各种全身性疾病。因此，我们认为外泌体具有“显着”的潜力，可以作为临床医生的宝贵工具，具有显着的优势。