This paper summarizes the authors' recent pioneering research work in piezoceramic-based smart aggregates and their innovative applications in concrete civil structures. The basic operating principle of smart aggregates is first introduced. The proposed smart aggregate is formed by embedding a waterproof piezoelectric patch with lead wires into a small concrete block. The proposed smart aggregates are multi-functional and can perform three major tasks: early-age concrete strength monitoring, impact detection and structural health monitoring. The proposed smart aggregates are embedded into the desired location before the casting of the concrete structure. The concrete strength development is monitored by observing the high frequency harmonic wave response of the smart aggregate. Impact on the concrete structure is detected by observing the open-circuit voltage of the piezoceramic patch in the smart aggregate. For structural health monitoring purposes, a smart aggregate-based active sensing system is designed for the concrete structure. Wavelet packet analysis is used as a signal-processing tool to analyze the sensor signal. A damage index based on the wavelet packet analysis is used to determine the structural health status. To better describe the time-history and location information of damage, two types of damage index matrices are proposed: a sensor-history damage index matrix and an actuator–sensor damage index matrix. To demonstrate the multi-functionality of the proposed smart aggregates, different types of concrete structures have been used as test objects, including concrete bridge bent-caps, concrete cylinders and a concrete frame. Experimental results have verified the effectiveness and the multi-functionality of the proposed smart aggregates. The multi-functional smart aggregates have the potential to be applied to the comprehensive monitoring of concrete structures from their earliest stages and throughout their lifetime.