## 4 Discussion
Essentially, we can currently choose between the tunnel technique and the coronally advanced flap technique with CTG [22; 23] to address multiple recessions in sextant V, with few studies [28; 30; 33] analyzing combined techniques such as that tested here. It was [PERSON] [30] who proposed the double lateral bridging flap technique as a procedure for covering gingival recessions in 1985. This same technique, with certain modifications, was described by [PERSON] [34] for deepening the vestibule. [PERSON] et al. [28] are among the few authors who have presented results on the double lateral bridging flap [30] technique with a follow-up of 5-8 years: in their 1993 study, complete root coverage was observed in 24% of the 75 gingival recessions treated in 18 patients. However, [PERSON] et al. [28] did not classify the severity of gingival recessions based on any standardized criteria (such as the Miller classification), meaning that their efficacy cannot be properly evaluated. Subsequently, [PERSON] et al. [35] described a modification of the [PERSON] technique [30] in a clinical case in the maxilla. This variation of the technique involved adding a connective tissue graft, in addition to the incision in the bottom of the vestibule, as well as mobilizing the flap coronally to cover multiple gingival recessions and to reconstruct the papilla in Miller class IV recessions. Another analysis of this technique was published by [PERSON] et al. [33] in 2014, based on findings derived from 15 recessions in seven subjects with a follow-up of up to 2 years. Both isolated and multiple recessions were treated in the mandibular anterior area, classified as Miller class I and II; bicuspids and canines were also included. This technique is similar to that used in the present study, i.e., a bilaminar technique with only one horizontal incision in the bottom of the vestibule. These researchers achieved complete RC in 11/15 recessions (73.3%) at 24 months; the mean RC was 90.6% \(\pm\) 16.8% and they obtained a mean KTW gain of 1.4 \(\pm\) 0.8 mm. Compared to the outcomes achieved by [PERSON] et al. [33], our results showed a slightly lower mean RC (80.5% vs. 90.6%), but this difference may be due to the fact that, unlike that research, the present study also included Miller class III defects in most of the treated cases. Moreover, further analysis of our data showed a mean RC of 95.8% when only Miller class II defects were included in the analysis, so our results appear to have high efficacy. Similarly, the observed KTW gain in our study was slightly higher (1.9 mm) than that reported in [PERSON] and colleagues' research (1.4 mm) [33]. It should be noted that we chose to analyze the gingival thickness parameter in our study, since recent literature [1] recommends evaluating the gingival biotype, due to the higher risk of development or progression of gingival recession in cases with periodontal biotypes of \(<\)1 mm. Based on the above, we have observed that recessions did not recur after 36 months of follow-up, reaching a medium-term gingival stability that could be accountable to the average GT gain having been greater than 1 mm (1.3 \(\pm\) 0.3 mm); therefore, statistically significant differences were found. Finally, in the study by [PERSON] et al. [33], a fine white scar located apically in the bottom of the vestibule, which was undetectable without intraoral inspection, was also observed in 71.4% of patients, whereas in our study this occurred in 57.1% of patients (Table 3). Therefore, in just over half the cases, this surgical technique involves an esthetic limitation: the formation of a small scar that is undetectable, given its location at the bottom of the vestibule. Nevertheless, the proposed treatment is a recommendable therapeutic option for patients with a shallow vestibule, coronal frenum insertion or mandibular incisors with a lack of keratinized tissue. Regarding the efficacy of other techniques to treat mandibular anterior recessions, it is worth highlighting the work of [PERSON] et al.