The paper summarizes the state-of-the-art of the most recent advances in biological nitrogen removal, including process design criteria and technological innovations. With reference to the Modified Ludzck Ettinger (MLE) process (pre-denitrification and nitrification in the activated sludge process), the most common nitrogen removal process used nowadays, a new design equation for the denitrification reactor based on specific denitrification rate (SDNR) has been proposed. In addition, factors influencing SDNR (DO in the anoxic reactor; hydrodynamic behavior) are analyzed, and technological solutions are proposed. Concerning technological advances, the paper presents a summary of various “deammonification” processes, better known by their patent names like ANAMMOX®, DEMON®, CANON®, ANITA® and others. These processes have already found applications in the treatment of high-strength wastewater such as digested sludge liquor and landfill leachate. Among other emerging denitrification technologies, consideration is given to the Membrane Biofilm Reactors (MBfRs) that can be operated both in oxidation and reduction mode.