Upper Paleolithic tools include blades made from elongated flakes, a wider variety of specialized forms, and the bone and antler tools that Middle Paleolithic craftspeople did not typically produce.

The transition between these levels at Denisova Cave, and the question of which tools were made by Neanderthals, Denisovans, or possibly modern humans (who may have passed through the region even before they established a sustained presence there), is one of the most interesting questions in the archaeology of the cave.

The remarkable bone artifacts from the upper levels — a needle made from bird bone, precisely shaped with a hole drilled through the eye end; pendants made from perforated animal teeth and shells — are among the most sophisticated objects from this period anywhere in the world.

They represent the kind of fine craft production that we associate with fully modern human behavior: the production of objects with no obvious subsistence function, apparently made for symbolic or aesthetic purposes.