The modified apically repositioned flap (MARF) technique has been previously published as a successful method to increase the zone of attached gingiva with numerous advantages, such as simplicity, predictability, and long-term stability. However, this technique has only been used in areas with at least 0.5 mm of attached gingiva, presurgically. In the current study, the MARF technique was utilized in 21 sites (teeth) with no attached gingiva and only mucosa comprising the marginal tissue. The long-term follow-up results over the course of 1 to 11 years (average follow-up: 3.2 years) show a statistically significant increase of 3.6 ± 0.8 mm for keratinized tissue and of 2.21 ± 0.83 mm for attached gingiva, and no increases in probing depths or marginal tissue recession. These results indicate that the MARF procedure has generated keratinized tissue and attached gingiva in areas with a presurgical absence of these tissues.