By Christian Fraser
BBC News, Rome
Mr Berlusconi faces pressure for more regional autonomy
He once compared himself to Jesus Christ.
Certainly he is risen again - but can Silvio Berlusconi deliver the miracles that Italy so badly needs?
His victory gives him a sizeable majority in both houses of parliament. In the deeply divided Senate, where the outgoing Prime Minister Romano Prodi had just a one-seat majority, the projections give Mr Berlusconi a majority of 37.
For the centre-left leader Walter Veltroni, who in the final days of the campaign had been closing the gap, it was a severe disappointment. He was punished for the sins of the previous government.
But it is the far left that paid the heaviest price. For the first time since World War II the Communists have no-one in parliament. Their leader Fausto Bertinotti, until two months ago was the leader of the lower house of parliament, resigned from the party.
"This is an electoral tsunami that redraws Italy's political landscape," wrote the left-leaning La Repubblica. "The guillotine has fallen," said Corriere della Sera, "... the heads roll".
Seven out of 10 voters chose either Mr Berlusconi's People of Freedom party or the centre-left's Democratic Party. In a country that has long struggled with the interests of the smaller parties, there are now just six remaining - 20 have been swept away.
Umberto Bossi wants tighter controls on immigration
Emerging from two years in the wings is a very strong centre-right alliance, which gives Mr Berlusconi enormous power to reform.
"Now we can govern like major Western democracies, with one major party in power and one major party in opposition," Mr Berlusconi said on Tuesday.
"With the extremists gone... we can get to work modernising this country."
But there is one smaller party, within Mr Berlusconi's coalition, that finds itself in a very strong position - the xenophobic Northern League.
The party scored more than 8% in the national vote, almost twice what it garnered in the last elections. It is no longer seeking independence for the north, as it initially did, but it demands extensive autonomy.
"We must put an end to the Rome-centric politics," said the party leader Umberto Bossi. "We'll demand federal control of our taxes - we want the money that is made by our region to stay in the region."
But Mr Bossi rejected the idea that they would hold Mr Berlusconi to ransom. "He's not a hostage," he said, "he's a friend".
And Mr Berlusconi will need all the friends he can get.
The economy has not grown in 10 years. Productivity is suffocated by bureaucracy, red tape and the cost of labour.
The new prime minister promises to ease the pressure by lowering taxes and trimming public spending. That is hardly enough.
At some 1,200bn euros (£960; $1,900), the national debt is the biggest in Europe. Technically Italy is still a member of the G8 group of leading industrialised nations. But this year the economy slipped behind that of Spain, and in real terms salaries are now half the value of those in Britain.
Mr Berlusconi is careful to limit expectations - there will no be quick fixes, he says. "We need to be strong, there are some difficult days ahead."
Mr Berlusconi has put the Naples rubbish crisis among his priorities
His first priority will be saving the flagship airline Alitalia, now on the brink of collapse.
Two weeks ago Air France-KLM walked away from a deal to buy the company, having failed to convince the recalcitrant unions that job cuts were inevitable. Air France have left the door open, but Mr Berlusconi is calling on the Italian business community to put forward an alternative bid.
It is Mr Berlusconi's influence in the business and media world that troubles his opponents. He still faces two trials for alleged corruption and he still has tight control of Italy's three commercial television stations - an obvious conflict of interest.
"It's time for him to give something up," said political commentator Beppe Severgnini. "He has to see that this dual role as prime minister and controller of commercial TV is not acceptable, not in a Western democracy. But I don't see him doing that. I just can't see the leopard changing his spots."
Maybe not, but the leopard must do better in his third term in office.
From 2001-2006 he led the longest-serving post-war government. His critics say it was a wasted opportunity. This time, with such a thumping majority, he has to deliver. Italy cannot afford for him to fail.