Biochemical oxidation and reduction are the principle of biological water and wastewater treatment, in which electron donor and/or acceptor shall be provided. Elemental sulfur (S⁰) as a non-toxic and easily available material with low price, possesses both reductive and oxidative characteristics, suggesting that it is a suitable material for water and wastewater treatment. Recent advanced understanding of S⁰-respiring microorganisms and their metabolism further stimulated the development of S⁰-based technologies. As such, S⁰-based biotechnologies have emerged as cost-effective and attractive alternatives to conventional biological methods for water and wastewater treatment. For instance, S⁰-driven autotrophic denitrification substantially lower the operational cost for nitrogen removal from water and wastewater, compared to the conventional process with exogenous carbon source supplementation. The introduction of S⁰ can also avoid secondary pollution commonly caused by overdose of organic carbon. S⁰ reduction processes cost-effectively mineralize organic matter with low sludge production. Biological sulfide production using S⁰ as electron acceptor is also an attractive technology for metal-laden wastewater treatment, e.g. acid mine drainage. This paper outlines an overview of the fundamentals, characteristics and advances of the S⁰-based biotechnologies and highlights the functional S⁰-related microorganisms. In particular, the mechanisms of microorganisms accessing insoluble S⁰ and feasibility to improve S⁰ bio-utilization efficiency are critically discussed. Additionally, the research knowledge gaps, current process limitations, and required further developments are identified and discussed.