This persistent abscess that does not get cleared with antibiotics is called Parulis as this elevated nodule is actually an opening of fistulous tract from some chronic abscess either in association with tooth (periapical abscess) or gum abscess or could be sinus in your case.
As I can not do physical exam hence can not say for sure about the origin of the abscess. It needs x-ray and second opinion of a dentist who can examine.
Another possibility is bony spicule left post surgically which is also a common finding and it can be removed easily. You should go for an X-ray of the region and also of the sinus to ensure complete drainage of same.
Yes, a local abscess can be cleared leaving the graft in place. Hope this satisfies your query.
You give me hope that I won't need a major cleaning out of the graft. I have had a CT scan and no fistula is showing. I had very bad inflammation right after the lift and also canker sores on the incision. It seems everything that could happen did. It was very painful and not healing very quickly. And I usually heal almost overnight. In hindsight I think the abscess appeared right away but was secondary to the canker sores for pain and also the inflammation pain seemed centered on my back tooth which was a 19 year old root canal so then had to have that re-treated and the root canal filling was just dust when opened up. It has been a very trying 4 months and how imperative is it to treat this abscess immediately?
CT scan is a very good option to look for sinuses and other bigger changes in the facial region like fractures etc. I would rather recommend a periapical x-ray (small dental x-ray) along with occlusal view x-ray used in dentistry as they can give meticulous details of the region involved. Also, they will even help evaluate the healing achieved so far. As your history was very troublesome hence healing may be delayed.
This retreated back tooth could also be the notorious element in delayed healing of the area. Get x-rays done to clear out the picture. If any visible flaw comes into picture then only you may require any treatment for the abscess otherwise it could be just a healing callus or bony spicule which may resolve with time. Hope this helps.
YOu have eased my worries somewhere but do you think I need to check out this swelling on the gum ASAP?? Thanks.