Italy coach Gian Piero Ventura has turned to Manolo Gabbiadini, Jorginho, and Alessandro Florenzi for Monday's decisive fixture versus Sweden.
The trio replaced Andrea Belotti, Daniele De Rossi, and the suspended Marco Verratti, who all appeared in Friday's 1-0 first-leg defeat in Solna.
Italy's 3-5-2 formation, meanwhile, remained unchanged.
To avoid missing the World Cup for the first time since 1958, the Azzurri must win by a two-goal margin. A 1-0 score would send the tie to extra time.