Pretty much all current motherboards are designed around the current ATX standard. The ATX standard specifies a number of design constraints including the voltages required for an ATX motherboard, the size of a motherboard, and the direction the powersupply fan blows in. That is merely the tip of the iceberg however. BTX attempts to address some of the shortcomings of the ATX standard with one of the key goals being better airflow - this has become increasingly important with processors from both Intel and AMD dissipating more heat. There are several companies that are aware of this - we've looked at products including the Aopen H700B that includes a vent that sits over the CPU fan that draws air in from outside the case. Several models from case maker Antec also do the same thing. This however is more an exception rather than a rule on the ATX front which should change with BTX.
We've also seen a massive increase in weight for heatsinks especially on the enthusiast front. The weight of a heatsink can warp a motherboard with no support - in fact many of the heavier heatsinks we have reviewed recommends that the user unmounts the heatsink before moving a computer around. BTX accounts for this as well with claims of "support features offer mechanical characteristics to support high loads".
Implementation of BTX so far is fairly limited on the boards that we have seen. The standard ATX plug has been replaced with a BTX connector which requires a few more pins from the powersupply but most boards account for this at the moment. As with the introduction of ATX, it took a while to slowly phase out AT style boards and BTX will likely have the same sort of gradual transition. BTX will also require the support of case manufacturers and until there is a high volume of boards out, this will not happen. It will be imperative for Intel to continue pushing BTX in order to convince manufacturers that there is a need to move on.