An advanced wastewater treatment technology, simple, uniform, reliable and stable in its operation, which at the same time is highly competitive from the economic and environmental point of view, is Moving Bed Biofilm Reactors (MBBR) performed with the contribution of bio-carriers. This review provides an overview of the most innovative and recent applications of several kinds of bio-carriers to improve wastewater treatment efficiency. In particular, the use of commercial plastic bio-carriers is presented, such as K1, K3, RK 04Z098, or bio-carriers of natural origin after modification of their surface, such as Loofah sponge coated with Bi24O31Br10 photocatalyst and Basalt fibers modified with ferric citrate. Research has shown that the most critical parameter that determines the performance of the MBBR technology is the appropriate design of the carrier in terms of its specific surface, material, texture, and orientation. 3D-printing technology provides the solution on optimization of the bio-carriers’ construction, having flexibility in the design and the possibility of choosing the desirable construction material. The utilization of 3D-printed bio-carriers to improve wastewater treatment performance is still in the early research stages, and almost all the research conducted in this direction is presented in this review.