<p>Silicate based bioactive glasses (SBGs) have emerged as versatile biomaterials with broad applications in tissue engineering and regenerative medicine. Their unique ability to chemically bond with bone and stimulate tissue regeneration is primarily attributed to the controlled release of biologically active ions, which promote cellular proliferation, differentiation, and hydroxyapatite formation. Since their discovery, SBGs have been extensively studied for their structural, chemical, and mechanical properties, which significantly influence their bioactivity and functional performance. The development of a bioactive interface between SBGs and host tissues involves a complex sequence of surface reactions, including ion exchange, silanol formation, polycondensation, and hydroxyapatite nucleation. These mechanisms underpin their applications in both hard- and soft-tissue repair. Clinically, SBGs have been employed in bone grafts, bone regeneration scaffolds, dental pulp protection, enamel remineralization, implant coatings, and the treatment of periodontitis and oral wounds. Moreover, functional modifications, including doping with therapeutic ions like Sr²⁺, Mg²⁺, Cu²⁺, and Ag⁺, enhance their osteogenic, angiogenic, and antibacterial properties, further expanding their clinical utility. Despite their significant potential, challenges such as mechanical brittleness, crystallization during processing, and controlled degradation persist, highlighting the need for composite or hybrid materials. This review provides a comprehensive overview of SBGs, covering their structure–property relationships, bioactivity mechanisms, functional enhancements, and current biomedical applications. Understanding these aspects is crucial for optimizing SBG design and facilitating their translation into clinical applications for effective tissue regeneration and dental therapeutics.</p>