By the time the surgery is done, the possible source becomes obvious: the periapical infection of the mesial root of #19 (Fig.10 arrowheads: from primary infection to secondary one).  Since there is also a furca lesion, possibly related to the post (P), the tooth #19 has guarded to poor prognosis. 

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Xin Wei, DDS, PhD, MS 1st edition 09/25/2014, last revision 03/23/2015