Abstract: The construction and maintenance of hydraulic and water transportation infrastructure in China generate over 10⁹ m³ of dredged sediment and spoil annually. Conventional disposal methods, primarily dumping and landfilling, impose severe dual pressures on land resources and the ecological environment. Consequently, converting these materials into engineered fill constitutes a viable resource utilization strategy capable of accommodating the large-scale consumption of dredged sediment and spoil. This paper systematically reviews two mainstream resource utilization technologies currently established: compacted fill utilization and flowable solidified backfill technology. The compacted fill technology involves mixing sediment with solidifying agents followed by mellowing; performance metrics such as compaction degree and bearing capacity are enhanced through rolling and compaction. This method is well-suited for engineering projects requiring traditional compaction control, such as embankments and roadbeds. Conversely, flowable solidified backfill technology prepares flowable filling materials by mixing sediment with binders, characterized by adjustable fluidity, strength, and density. This approach is applicable in scenarios where conventional compaction processes are difficult to implement. Regarding material evolution, solidifying agents are transitioning from traditional cement and lime-based materials toward high-efficiency, cost-effective, green, and low-carbon multi-component composite binders. In terms of equipment, in-situ solidification machinery has emerged as a critical tool for on-site treatment due to its superior adaptability, while efficient in-pipe flowable solidification technologies and equipment represent a current research hotspot. Future perspectives suggest that priority should be given to developing intelligent mix design platforms based on big data and artificial intelligence (AI) to foster high-quality utilization technologies with high added value, economic viability, and environmental sustainability. Furthermore, the utilization of dredged sediment and spoil as fill material should be adapted to local conditions and timing, with active exploration into establishing regional processing centers. It is imperative to promulgate technical standards and relevant policies at both industry and national levels to guide and regulate the resource utilization of dredged sediment and spoil as fill material, thereby facilitating the integrated development of the national water network and shipping networks, and advancing the construction of aquatic ecological civilization.