Although most of the pixel “intelligence” is normally found on the electronics side, some important progress has been recently achieved in radiation sensors themselves, allowing for significant performance improvement and new application opportunities. This paper is focused on the most interesting elements of novelty that have characterized pixel sensors in the past few years, with emphasis on device and technological aspects. In particular, sensors exploiting the third dimension in silicon (i.e., 3D sensors and active edge sensors) are reviewed in detail.