The development of zirconia dental implants has become increasingly popular over the last years due to the outstanding mechanical properties, superior aesthetic appearance and high biocompatibility of this material. However, premature implant failure as a result of an incomplete osseointegration still represents a major concern. In this sense, surface modifications have been applied to dental zirconia to improve the biological interactions of the implant with the surrounding tissue. Nevertheless, surface modification of zirconia is challenging due to the formation of a monoclinic phase associated with ageing and loss of mechanical integrity. This review focuses on the most common surface topographical modification strategies currently applied to zirconia, namely grinding, sandblasting, chemical etching and laser treatment. A comprehensive and comparative analysis has been performed to assess the effects of these techniques on the physicochemical properties, mechanical performance, hydrothermal degradation behavior and biological response of the modified surfaces.