This review presents a comprehensive state-of-the-art technology at ECC that summarizes and critically revises research on PZT, self-sensing, and self-healing concrete. Concepts, methods, and applications used in cement-based sensors are reviewed, and missing aspects and suggestions for future studies are presented. Recent studies have shown that additives are added (e.g., lead zirconate titanate, barium zirconate titanate, nanomaterials, and fibers) to improve the piezoelectric capacity of the cementitious composite. Cement-based piezoresistive sensors have significant potential to monitor the behavior of concrete under rheology, mechanical loading, and durability. The achievement of using a structural material for this effect is that it costs less and is more durable than integrated or embedded devices. Similarly, applications of different mineral and bio-additive materials to induce the self-healing of cracks have received great attention. In addition, greening cement materials resulting from the use of high volumes of industrial wastes in self-healing and self-sensing concrete have wide potential applications in SHM. Furthermore, self-sensing and self-healing materials can help provide structural integrity and safety, extend the life of structures, increase traffic safety and efficiency, as well as reduce resource and energy consumption. Despite all these positive developments, there are currently a number of serious research challenges for these materials.