From donor programming to therapeutic performance: An evidence-calibrated narrative review of dental mesenchymal stromal/stem cell-derived extracellular vesicle preparations in oral and maxillofacial regeneration.

Dental mesenchymal stromal/stem cell-derived extracellular vesicle preparations are being investigated as cell-free interventions for oral and maxillofacial regeneration, but the evidence is heterogeneous in donor state, product identity, delivery context and endpoint level. This critical narrative review separates mechanistic confidence from translational readiness. Representative studies are mapped across dental pulp, periodontal ligament, deciduous-tooth, dental follicle, apical-papilla and gingival sources, while conditioned medium, secretome, small extracellular vesicle preparations, author-labelled exosome preparations, combined carrier-drug interventions and apoptotic vesicle preparations are kept distinct. The synthesis indicates that donor programming can yield directionally different outcomes across study-specific contexts; carrier-associated structural outcomes cannot automatically be assigned to a particle preparation; and molecular, histological and imaging outcomes do not establish durable organ function. Translation requires defined identity and purity, justified dose normalization, potency, batch comparability, stability, exposure, safety, manufacturing controls and indication-matched functional testing.