A medical examiner in Florida ruled that the death of a 44-year-old dental patient during a dental implant procedure was accidental, and, therefore, no criminal charges will be filed, according to a story published on April 3 in First Coast News.
The results of the autopsy revealed that the cause of Roy Estes III's death was multiple drug intoxication. The combined toxicity of mitragynine, the primary alkaloid found in the herbal supplement kratom that is taken to manage pain, the antidepressant fluoxetine, the antihistamine diphenhydramine, and the anesthetic bupivacaine led to his death.
Dr. Francesco Sebastiani -- who practices in Ponte Vedra, FL, and performed the procedure on Estes -- will not be charged.
In October 2025, Estes went to Sebastiani to have 23 teeth extracted and 10 implants placed. Midway through the hourslong procedure, Estes stopped breathing. An ambulance was called, but Estes died at the practice.
Other than the bupivacaine, all medications found in Estes were taken before his dental appointment. According to the medical examiner's report, the medications were at concentrations within toxic ranges.
Furthermore, the report noted there was no documentation about the dose, route, and timing of the anesthetic. Therefore, Estes' death could not be definitely attributed to one single agent, according to the story.
The medical examiner’s report states that “Nonetheless, the totality of evidence supports death due to combined mitragynine-associated cardiotoxicity potentiated by bupivacaine, fluoxetine, and diphenhydramine exposure,” according to the story.
Estes' fiancé, Amy Rowell, said that Estes told Sebastiani about all the medications he had taken the morning of the procedure. However, Sebastiani denied those claims, according to the story.
Though Sebastiani’s dental license remains active, he faces two administrative complaints, including one involving another patient death, filed by the Florida Department of Health. The health department is seeking discipline that could lead to Sebastiani's license being revoked.
One complaint alleges that Sebastiani failed to properly monitor and record the vital signs and respiration of patient Colleen Krause Straw. She died in 2023 from complications days after a dental implant procedure. Sebastiani has an administrative hearing scheduled later this month, according to the story.
In March 2026, Sebastiani allegedly violated a state statute related to fraudulent, false, deceptive, or misleading advertising on his website.
A criminal complaint is merely an allegation. All defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
