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Sweden won gold the last time Italy hosted the Games 20 years ago and worked out their early kinks as captain Gabriel Landeskog, defencemen Gustav Forsling and Victor Hedman, and forwards William Nylander and Mika Zibanejad each scored.
Swedish goaltender Filip Gustavsson lost his stick as he was coming out to play the puck in the fifth minute, and Italy's Luca Frigo leaped on the loose puck and rifled it into the net as the home crowd erupted in utter joy.
Landeskog quieted the cheers when he levelled the game on the power play before Forsling ripped a vicious slapshot past the Italian goalie to grab the lead before the first intermission.
But the Italians made it 2-2 with a bit of trickery early in the second, as Dustin Gazley sneaked behind the net and fed the puck to Matt Bradley, who rifled it past the Swedish goalie's glove, again sending the sea of home fans into a frenzy.
Nylander tapped in a rebound late in the second period to take back the lead and New York Rangers centre Zibanejad directed the puck into the top right corner late in the third before Hedman sent one into the empty net to close out the scoring.
Goalie Damian Clara, Italy's homegrown Anaheim Ducks prospect, went off limping midway through the third period, clouding an otherwise dream Olympic debut for the 21-year-old, who turned away 46 shots.
Sweden ultimately outshot Italy 60-22.