Temporomandibular joint osteoarthritis (TMJOA) is a common degenerative disorder in maxillofacial surgery, whose pathogenesis involves the complex interplay among abnormal mechanical loading, inflammatory cascades, and subchondral bone remodeling. Piezo1, a mechanosensitive cation channel recognized in the 2021 Nobel Prize, has recently been identified to play a central role in mechanotransduction of TMJ chondrocytes. This paper systematically reviews the research progress regarding the expression regulation, signaling pathways, positive inflammatory feedback mechanisms, and subchondral bone remodeling of Piezo1 in TMJOA. In conjunction with the requirements of maxillofacial aesthetic restoration, it further discusses Piezo1-targeted pharmacological interventions and tissue engineering regenerative approaches, aiming to provide novel theoretical references for the functional and aesthetic reconstruction of the temporomandibular joint in clinical practice.