Sand filtration systems have long served as a cornerstone in water and wastewater treatment, offering a reliable and cost-effective method for removing suspended solids and improving water quality. Recent advances in materials science, engineering configurations, and digital technologies have significantly transformed the design and efficiency of sand filter beds. This review explores the evolution of materials used in modern sand filter beds, including alternative media such as crushed glass, zeolites, and biochar, which offer enhanced filtration performance and sustainability. It examines innovative configurations and techniques that improve filtration rates, reduce maintenance, and optimize space utilization. The integration of intelligent digital technologies—such as real-time monitoring, predictive maintenance, and data-driven optimization—is discussed as a key enabler of smart filtration systems. The review also highlights automation strategies and control systems that enhance operational efficiency and reduce labor intensity. Additionally, the emergence of hybrid systems that combine sand filtration with complementary technologies such as membrane filtration, UV disinfection, and advanced oxidation processes is analyzed for their potential in achieving higher treatment standards. Collectively, these advancements are shaping a new generation of sand filter systems that are more efficient, adaptive, and sustainable. The paper concludes by identifying research gaps and proposing future directions for innovation in this essential area of water treatment technology.