Innovations in nanomaterial science, engineering and printing technologies have increasingly driven advances in electrochemical sensing. Screen-printed electrodes (SPEs) have become a versatile, low-cost, and scalable solution for developing portable electrochemical detection platforms. However, their analytical performance remains intrinsically limited by surface area, electron transfer efficiency, and the immobilization of biomolecules. Recent developments in nanostructured materials, ranging from two-dimensional (2D) materials such as graphene, MXenes, and transition metal dichalcogenides, to one-dimensional nanostructures and hybrid nanocomposites, have transformed the signal transduction landscape of SPE-based electrochemical sensors. Integration of nanomaterials into SPEs has successfully transformed their analytical capabilities, but the diversity of materials and modification strategies has made it difficult to consolidate current knowledge in the field. Strategies that integrate nanomaterials via ink formulation, surface modification, or in situ growth have yielded sensors with unprecedented sensitivity, reproducibility, and selectivity across various chemical and biological targets. This review offers a cross-material synthesis of how nanomaterial engineering transforms the electrochemical performance of SPEs. By integrating insights across morphology, interfacial chemistry, and device-level behavior, it establishes a unified perspective that has been missing from the current literature and clarifies the design principles driving next-generation SPE-based sensing platforms.