Temporomandibular joint osteoarthritis (TMJOA) is a common degenerative disease in maxillofacial surgery. Its pathogenesis involves the complex interaction among abnormal mechanical loading, inflammatory cascade, and subchondral bone remodeling. Piezo1, a mechanosensitive cation channel conffrmed by the 2021 Nobel Prize, has been found to play a central role in mechanotransduction of temporomandibular joint (TMJ) chondrocytes in recent years. This paper systematically reviews the research progress of Piezo1 in expression regulation, signaling pathways, positive feedback mechanism of inffammation and subchondral bone remodeling in TMJOA. Combined with the requirements of maxillofacial aesthetic restoration, it further discusses the Piezo1-targeted drug intervention strategies and tissue engineering regeneration approaches, so as to provide a new theoretical reference for clinical reconstruction of TMJ function and aesthetics.