## 4 Discussion  
The present study was carried out to evaluate the clinical and esthetic efficacy of treating recessions in mandibular incis by performing the double lateral sliding bridge flap technique with CTG. This traditional technique was specifically designed to cover isolated and multiple gingival recessions at both the maxillary and mandibular levels [30]. Originally, clinicians did not use the CTG, but simply manipulated the flap by moving it coronally to achieve their root coverage goal [30]. The results obtained in the present study prove that a CTG together with the double lateral sliding bridge flap technique is a valid  
\begin{table}
\begin{tabular}{l c c c c c c c c c c c} \hline \hline  & & & & & & & & & & & & \\ \hline \multirow{2}{*}{**Parameter**} & \multicolumn{3}{c}{**Level of Gingival**} & \multicolumn{3}{c}{**Marginal Tissue**} & \multicolumn{3}{c}{**Soft Tissue**} & \multicolumn{3}{c}{**Mucogingival**} & \multicolumn{3}{c}{**Gingival**} \\  & \multicolumn{3}{c}{**Margin \({}^{*}\)**} & \multicolumn{3}{c}{**Contour \({}^{**}\)**} & \multicolumn{3}{c}{**Texture ***} & \multicolumn{3}{c}{**Junction ****} & \multicolumn{3}{c}{**Color ******} \\ \hline TF & & & & & & & & & & & \\ \hline Score & 0 & 3 & 6 & 0 & 1 & 0 & 1 & 0 & 1 & 0 & 1 \\ \hline n. (\%) & 1 & 4 & 9 & 4 & 10 & 8 & 6 & 4 & 10 & 3 & 11 \\  & (7.1) & (28.6) & (64.3) & (28.6) & (71.4) & (57.1) & (42.9) & (28.6) & (71.4)treatment option for the coverage of gingival recessions in the mandibular anterior region. Predictable techniques, such as pedicled flaps (positioned either laterally or coronally) covering the denuded root surface, with or without the use of a CTG, are available to reconstruct the soft tissues over the recession [9; 18; 19]. Systematic reviews have evaluated the efficacy of these procedures to establish root coverage percentages ranging from 35% to 97%, and conclude that subepithelial connective tissue grafting (obtained from the palatal mucosa) is the surgical treatment producing the best results [31; 32]. As we expected to fully correct all the recessions treated with this technique, we did not estimate the sample size at baseline, although we knew that a previous clinical trial in which this technique had been used evaluated 15 recessions in seven patients and found significant pre-post differences [33]. Currently, based on the data dispersion for gingival recession depth after 36 months of follow up (2.5 \(\pm\) 1.5 mm), we can estimate that the recommended sample size for this pre-post comparison is seven recessions, with a power of 80% and an alpha error of 0.05. Since a control/placebo group may not be ethically viable, we used baseline data as controls to legitimate pre-post comparisons. For the treatment of isolated mandibular gingival recessions, several surgical techniques have been proposed, including the use of a free gingival graft (FGG) [16] or CTG combined with various flap designs, such as the envelope flap [17], coronally advanced flap [18], laterally sliding flap [19], double pedicle flap [20], or laterally closed tunnel technique [21]. However, the scant literature we have found on the treatment of isolated and multiple recessions in sextant V using the bridge flap technique is limited to case series [28; 30; 33]. Furthermore, treating multiple recessions at the mandibular anterior level is more challenging, as there may be anatomical variants that affect the prognosis [1]. [PERSON] et al. [10] performed a systematic review and meta-analysis in which they evaluated the efficacy of the following techniques: coronally advanced flap, modified coronally advanced flap, modified coronally advanced flap, and modified coronally advanced tunnel, in multiple recessions at both the level of the fifth sextant and the upper maxilla. Their findings suggest that the various surgical treatments are associated with moderate to high levels of clinical efficacy, obtaining more than 80% RC for Miller class I, II, and III recessions. However, none of them has become the gold standard technique.