CAMBRA Protocol Efficacy: A Systematic Review and Critical Appraisal

The Caries Management by Risk Assessment (CAMBRA) protocol consists of analyzing the patient's profile by assessing the risk and protective factors and assigning a risk level to the patient to allow an individualized treatment plan, which combines restorative treatments with a preventive chemical therapy. This systematic review and critical appraisal aim to evaluate the effectiveness of the CAMBRA protocol in reducing the incidence of caries lesions and oral bacterial load. An electronic search was carried out in the Cochrane Library, PubMed, Web of Science, Scopus, and Embase databases. Clinical studies evaluating the incidence of dental caries lesions and/or the reduction of cariogenic bacterial load (Streptococcus mutans and/or Lactobacilli spp.), with at least an intervention group that follows the CAMBRA protocol and a control group published up until January 2022, were included. The methodological quality assessment of the included clinical studies was assessed through the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2). The quality of the case-control study was evaluated according to the Methodological Index for Non-Randomized Studies (ROBINS-I). There is currently no scientific evidence to recommend the integration of the CAMBRA protocol into clinical practice. The results reported by the studies included in the systematic review do not suggest a decrease in the incidence of dental caries lesions and/or bacterial load. There is a clear need for the development of new clinical studies with an adequate methodology and follow-up, both for the CAMBRA protocol and for its components individually.