Dengue virus (DENV) remains a pressing global health challenge, primarily transmitted by Aedes aegypti mosquitoes. This review synthesizes current knowledge on the biological, environmental, and molecular factors influencing DENV transmission, drawing upon 120 peer-reviewed studies. The narrative analysis highlights the mosquito’s vector competence, shaped by genetic variability, midgut barriers, and immune responses. Environmental drivers particularly temperature, humidity, and urbanization emerge as critical determinants of transmission dynamics. A meta-analysis of 30 studies reveals a strong positive correlation (r = 0.85, p < 0.01) between temperature (25 °C–30 °C) and transmission efficiency. Proteomic studies further detail molecular interactions facilitating viral entry and replication. Although novel interventions such as Wolbachia-based biocontrol and genetic modification show promise, context-specific implementation remains challenging, especially in low-resource settings. Key research gaps include the impact of climate change, co-infections with other arboviruses, and the long-term efficacy of vector control innovations. Prioritizing interdisciplinary approaches and adapting strategies to local contexts are vital to reducing the dengue burden and informing future public health responses.