Background: One of the main reasons for tooth loss and functional incompatibility of dentition is periodontitis which is a multi-factorial disease. Among the main reasons for periodontitis is inflammation.
Hypothesis: Some keystone bacteria, such as Prophyromonas gingivalis with a notable number of virulence factors could activate and modify inflammatory pathways in gingiva. A well-established therapy for this disease is topical antibiotics; however, these treatments have side effects and could promote antibiotic-resistant infections as well. Such antibiotic-resistant infections are a group of periodontitis with a severely complicated treatment approach that could fail. Thus, new strategies need to be developed for treatment-resistant (antibiotic-resistant) periodontitis. In the past decades, many randomized controlled clinical trials have shown that mesenchymal stromal cells (MSCs) could treat inflammatory-dependent diseases or disorders. In addition to MSCs, the anti-inflammatory effects of their extracellular vesicles (EVs) have also been studied in the clinic. 
Results: Considering the anti-inflammatory potential of MSCs-derived EVs, it could be hypothesized that local delivery of these EVs could be an effective method for periodontal treatment due to the accessible location of the periodontium.
Conclusion: This study suggests further in vivo studies and randomized clinical trials on the potential effects of MSCs-derived EVs on periodontal disease treatment.