The complete absence of keratinized attached gingiva on the buccal surface of a tooth can make the area more susceptible to gingival recession. The modified apically repositioned flap (MARF) technique is an effective procedure to increase the dimensions of attached gingiva in areas that present with some existing keratinized tissue. The objective of this case report is to present long-term clinical and histologic evidence that the MARF technique can be used to create attached gingiva in areas that lack keratinized tissue.