The article reviews the progress, challenges, and prospects of exosomes and exosome-loaded composite scaffolds in periodontal tissue engineering. Exosomes, small extracellular vesicles secreted by various cells, have emerged as promising alternatives to stem cell therapy due to their therapeutic effects comparable to those of stem cells. They regulate immune function, inflammation, microbiota, and tissue regeneration, showing good potential in periodontal tissue regeneration. The combination of exosomes with biomaterial scaffolds maximizes their therapeutic advantages. The article discusses the biogenesis, composition, and extraction methods of exosomes, highlighting their immunomodulatory and inflammatory regulatory properties. Exosomes promote periodontal tissue repair through mechanisms such as immunoregulation, promotion of endogenous stem cell regeneration and differentiation, and angiogenesis. However, challenges remain, including the short half-life of exosomes in vivo and the difficulty in achieving sustained release. The article also explores the use of exosome composite scaffolds, which can effectively retain exosomes at the implantation site while preserving their activity and ensuring sustained release. Various composite technologies, such as chemical crosslinking, physical adsorption, freeze-drying, 3D printing, and specific binding, are used to fabricate these scaffolds. The application of exosome composite scaffolds in periodontal regeneration has shown significant therapeutic effects, but further research is needed to overcome limitations and improve their performance.The article reviews the progress, challenges, and prospects of exosomes and exosome-loaded composite scaffolds in periodontal tissue engineering. Exosomes, small extracellular vesicles secreted by various cells, have emerged as promising alternatives to stem cell therapy due to their therapeutic effects comparable to those of stem cells. They regulate immune function, inflammation, microbiota, and tissue regeneration, showing good potential in periodontal tissue regeneration. The combination of exosomes with biomaterial scaffolds maximizes their therapeutic advantages. The article discusses the biogenesis, composition, and extraction methods of exosomes, highlighting their immunomodulatory and inflammatory regulatory properties. Exosomes promote periodontal tissue repair through mechanisms such as immunoregulation, promotion of endogenous stem cell regeneration and differentiation, and angiogenesis. However, challenges remain, including the short half-life of exosomes in vivo and the difficulty in achieving sustained release. The article also explores the use of exosome composite scaffolds, which can effectively retain exosomes at the implantation site while preserving their activity and ensuring sustained release. Various composite technologies, such as chemical crosslinking, physical adsorption, freeze-drying, 3D printing, and specific binding, are used to fabricate these scaffolds. The application of exosome composite scaffolds in periodontal regeneration has shown significant therapeutic effects, but further research is needed to overcome limitations and improve their performance.