Periodate oxidation of polysaccharides has transitioned from structural analysis into a modification method for engineered materials. This review summarizes the research on this topic. Fibers, fibrils, crystals, and molecules originating from forests that have been subjected to periodate oxidation can be crosslinked with other entities via the generated aldehyde functionality, that can also be oxidized or reduced to carboxyl or alcohol functionality or used as a starting point for further modification. Periodate-oxidized materials can be subjected to thermal transitions that differ from the native cellulose. Oxidation of polysaccharides originating from forests often features oxidation of structures rather than liberated molecules. This leads to changes in macro, micro, and supramolecular assemblies and consequently to alterations in physical properties. This review focuses on these aspects of the modulation of structural hierarchies due to periodate oxidation.