Objective <p>This review aims to comprehensively summarize the basic principles of piezoelectric biomaterials, their material classifications, and their applications in tissue engineering. It focuses on elucidating the molecular mechanisms by which piezoelectric stimulation regulates cell behavior and evaluates the translational potential of these materials in regenerative medicine.</p> Method <p>We systematically reviewed the literature on piezoelectric materials in tissue engineering, covering inorganic, organic, and composite piezoelectric materials. This review integrates in vitro and in vivo study results across various regenerative fields, including bone, cartilage, nerve, skin, cardiovascular, and dental tissues. It also summarizes the key molecular signaling pathways involved in piezoelectric stimulation.</p> Results <p>Piezoelectric materials effectively convert mechanical energy into localized electrical signals, mimicking endogenous bioelectric cues. They promote tissue regeneration by modulating Ca²⁺ influx via mechanosensitive ion channels, activating integrin-FAK signaling, and regulating pathways such as Wnt/β-catenin, TGF-β, and MAPK/ERK. Applications in bone, cartilage, nerve, skin, cardiovascular, and dental regeneration demonstrate broad therapeutic potential. However, challenges remain in material optimization, long-term biosafety, and clinical translation.</p> Conclusion <p>Piezoelectric biomaterials offer a promising “self-powered” strategy for tissue regeneration by replicating native electromechanical microenvironments. Future advances will depend on the development of intelligent composites, integration with advanced fabrication technologies, and a deeper understanding of cell-material interactions to enable safe and effective clinical translation.</p>