Micro-computed tomography (micro-CT) is an invaluable tool for the evaluation of dental implant success, whereby the assessment of bone microstructure is conducted. This review examines the role of micro-CT in evaluating bone microstructure in dental implants. A review of the current literature reveals that micro-CT enables the accurate measurement of bone volume, trabecular morphology, and connectivity density, all of which play a crucial role in implant stability. The high-resolution three-dimensional visualization capabilities of micro-CT are also beneficial for the analysis of osseointegration and the evaluation of bone augmentation biomaterials. Despite the existence of challenges such as imaging artifacts and limitations in in vivo applications, advancements in sub-micron resolution and artificial intelligence integration offer promise for improving diagnostic capabilities. Micro-CT provides valuable insights into bone microarchitecture and osseointegration dynamics, which have the potential to enhance pre-operative planning and clinical outcomes in dental implantology. Future research should prioritize the standardization of micro-CT analysis protocols and the exploration of direct clinical applications of this technology.